RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXXXX	CASE:  PD-2014-02662
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20041130

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an National Guard E5, Automated Logistics Specialist, medically separated for “chronic right knee pain,” with a disability rating of 10%.

CI CONTENTION:  “Please consider all conditions.”  The CI’s complete submission is at Exhibit A.  

SCOPE OF REVIEW:  The Board’s scope of review is defined in DoDI 6040.44.  It is limited to those conditions determined by the Physical Evaluation Board (PEB) to be unfitting for continued military service and when specifically requested by the CI, those conditions identified by the PEB, but determined to be not unfitting.  Any conditions outside the Board’s defined scope of review and any contention not requested in this application may remain eligible for future consideration by the Board for Correction of Military Records.  Furthermore, the Board’s authority is limited to assessing the fairness and accuracy of PEB rating determinations and recommending corrections, where appropriate.  The Board’s assessment of the PEB rating determinations is based upon a review of medical records and all available evidence for application of the Veterans Affairs Schedule for Rating Disabilities (VASRD) standards to the unfitting medical condition at the time of separation.  The Board has neither the role nor the authority to compensate for post-separation progression or complications of service-connected conditions.  That role and authority is granted by Congress to the Department of Veterans Affairs, operating under a different set of laws.  The Board gives consideration to VA evidence, particularly within 12 months of separation, but only to the extent that it reasonably reflects the severity of the disability at the time of separation.  

RATING COMPARISON:  

SERVICE PEB - 20040917	VARD - 20050427	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Right Knee Pain	5259	10%	Right Knee Arthroscopic Repair	5259	10%	20050310	
			Scars, Right Knee	7805	0%	20050310	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  20%	

ANALYSIS SUMMARY:  

Chronic Right Knee Pain.  According to the service treatment record (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), this CI had right knee surgery in March 2004 for a medial meniscal tear.  The tear was irreparable, and the meniscus was debrided (removal of dead or damaged tissue, to improve healing).  Following surgery further treatment did not result in improvement sufficient to allow unrestricted duty.  The MEB forwarded “chronic right knee pain secondary to osteoarthritis and medial meniscal tear, without improvement with surgery” for PEB adjudication.  At the physical therapy (PT) appointment on 6 April 2004, 8 months prior to separation, physical examination showed good quadriceps muscle tone, with joint effusion.  Range of motion (ROM) testing showed flexion of 130 degrees (140 normal) and a normal extension of 0 degrees.  Three weeks later, on 29 April 2004, the CI was seen by orthopedics.  The examiner recorded full ROM, trace effusion, some tenderness to palpation, and ligaments were intact.  During the MEB examination dated 29 June 2004, 5 months prior to separation, the CI reported constant knee pain rated at 3/10.  The pain was exacerbated by walking on uneven ground, impact activities, or twisting, and the pain was relieved by rest.  Physical examination showed ROM measurements as flexion of 126 degrees and a normal extension.  There was medial joint line tenderness, no effusion, and all tests for joint instability were negative.

At the 10 March 2005 VA Compensation and Pension (C&P) evaluation, performed 3 months after separation, the CI reported right knee pain that was 4/10 in severity, and increased with weight bearing.  The CI did not use a brace or supportive device, except during hunting or hiking as the knee became unstable during these activities.  Physical examination showed an upright and steady gait, with no ambulatory aids used.  The CI was able to perform a full squat, and could duck waddle without difficulty. ROM measures were flexion of 130 degrees, and a normal extension.  There was no laxity, joint line tenderness or patellar compression tenderness.  All tests for joint instability or meniscal damage were negative.  No additional weakness or fatigability were noted with repetitive motion.

The Board directed attention to its rating recommendation based on the evidence.  The PEB assigned a 10% rating under the 5259 code (cartilage, semilunar, removal of, symptomatic), citing the right knee was symptomatic status post cartilage removal.  The VA also rated the right knee condition 10%, coded 5259, citing symptomatic removal of the semilunar cartilage of the knee.  There was no limitation of motion which supported a rating under the diagnostic codes for limitation of flexion or extension (5260, 5261).  However, the Board agreed that there was evidence of persistent pain after meniscal surgery, warranting a 10% rating under the 5259 code.  The examinations proximate to separation did not demonstrate any ligamentous instability or laxity (5257), and there was no history of dislocated meniscus or loose body causing frequent locking with recurrent effusions (5258), to support a rating under the respective codes.  There was no fracture, non-union, or malunion of the femur or tibia to support consideration under the respective codes for knee impairment related to long bone conditions (5255, 5262).  There was therefore no VASRD §4.71a route to a rating higher than the 10% adjudicated by the PEB, under any applicable code, and no grounds for additional rating based on the presence of instability. After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the Board found insufficient cause to recommend a change in the PEB adjudication for the chronic right knee pain.   

BOARD FINDINGS:  In the matter of the chronic right knee pain, and IAW VASRD §4.71a, the Board unanimously recommends no change in the PEB adjudication.  There were no other conditions within the Board’s scope of review for consideration.  The Board, therefore, recommends that there be no re-characterization of the CI’s disability and separation determination.

The following documentary evidence was considered:
Exhibit A.  DD Form 294, dated 20140420, w/attachments
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

MEMORANDUM FOR Commander, US Army Physical Disability Agency
(AHRC-DO), 2900 Crystal Drive, Suite 300, Arlington, VA 22202-3557

SUBJECT: Department of Defense Physical Disability Board of Review Recommendation
for XXXXXXXXXXXXXXXXXXXXX AR20160011465 (PD201402662)

I have reviewed the enclosed Department of Defense Physical Disability Board of
Review (DoD PDBR) recommendation and record of proceedings pertaining to the
subject individual. Under the authority of Title 10, United States Code, section 1554a,
I accept the Board's recommendation and hereby deny the individual's application.

This decision is final. The individual concerned, counsel (if any), and any Members of
Congress who have shown interest in this application have been notified of this decision
by mail.

BY ORDER OF THE SECRETARY OF THE ARMY:

Enclosure

CF:
( ) DoD PDBR
( ) DVA