RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX.  	CASE:  PD-2014-02671
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20071105

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty, E5, Water Treatment Specialist, medically separated for “chronic right knee pain (osteochondritis)” with a disability rating of 0%.

CI CONTENTION:  His right knee condition continues to worsen and negatively impact his daily activities.  He was not evaluated for other conditions.  The 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 confined to 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 - 20070905	VARD - 20080507	
Condition	Code	Rating	Condition	Code	Rating	Exams	
Chronic Right Knee Pain (Osteochondritis)	5099-5003	0%	Post-Operative Internal Derangement of the Right Knee	5261	20%	2007092820071126	
			Scars, Right Knee	7804	0%	2007092820071126	
COMBINED RATING:  0%	COMBINED RATING OF ALL VA CONDITIONS:  60%	

ANALYSIS SUMMARY:  

Right Knee Condition.  According to service treatment records (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI suffered chronic right knee pain which was exacerbated by a sports injury in March 2004.  He was diagnosed with an osteochondral defect (OCD - an area of destruction of the smooth articular surface of the bone); and, underwent a series of three surgeries in November 2004 (arthroscopic microfracture of the OCD), May 2005 (arthroscopic debridement), and September 2005 (autologous chondrocyte implantation).  Post-operative clinical entries documented an uncomplicated surgical recovery with progressive ambulation and improving range of motion (ROM).  A physical therapy (PT) entry of 30 November 2005 (3 months after the last surgery and 24 months before separation) noted that the CI was “ambulating without an assistive device” with no effusion and flexion to 115 degrees  (normal 140, 45 for minimum 10%).  A persistent trial of conservative treatment over the ensuing two years, however, did not result in improvement sufficient to allow unrestricted duty, and the MEB forwarded “right knee medial femoral condyle [OCD]” for PEB adjudication.  Magnetic resonance imaging (MRI) in February 2007 (9 months prior to separation) demonstrated a suspected meniscal tear (no additional surgery recommended) and a persistent OCD lesion; but, specifically noted that all ligaments (cruciates and collaterals) were intact.  

The NARSUM on 18 July 2007, performed 3½ months before separation, noted complaints of persistent right knee pain interfering with running, climbing, negotiating stairs, and prolonged driving.  The physical examination recorded tenderness, stability to stress testing in all planes, and “full” ROM.   The NARSUM referred to earlier formal ROM measurements for the MEB by PT on 3 May 2007 (6 months before separation) which documented flexion to 115 degrees and extension of minus 5 degrees (normal 0, minus 10 degrees for minimum 10%), specifying painful motion.  That examiner also documented a normal Lachman’s test (no anterior instability).

At the VA Compensation and Pension (C&P) examination on 28 September 2007, performed 5 weeks before separation, the CI reported baseline pain rated 4/10 with flares to 9/10 by climbing, squatting, and prolonged sitting, standing, or walking.  The physical examination recorded a “mildly antalgic gait,” tenderness, crepitus, a “mild” effusion, and negative signs of impingement (locking).  A “mildly positive” Lachman’s was noted, but the joint was stable to medial and lateral stress.  The ROM was flexion to 140 degrees with extension of minus 20 degrees (30% rating threshold).  At a second VA C&P examination conducted on 26 November 2007 (3 weeks after separation), the CI reported the use of a knee brace for exercising and complained of subjective buckling with exercise and stair climbing.  The physical examination recorded a “noticeable limp,” tenderness, a “noticeable” effusion, negative impingement, and stability to stress testing in all planes.  The ROM was flexion to 120 degrees (accommodating a 10 degree DeLuca deduction) and extension of minus 15 degrees (accommodating a 5 degree DeLuca deduction, 20% rating threshold).  There was additional probative evidence from a VA orthopedic clinic appointment on 17 January 2008, performed 10 weeks after separation.  This documented a normal gait, tenderness and crepitus, flexion to 140 degrees and extension of minus 5 degrees. 

The Board directed attention to its rating recommendation based on the above evidence.  The PEB rated the right knee condition 0%, coded analogously to 5003 (arthritis, degenerative), citing involvement of only one joint.  Members agreed, however, that painful motion was well supported by the Service evidence in justification of the minimum 10% rating.  The VA rated 20% under code 5261 (limitation of extension), referencing the ROM evidence from the post-separation C&P (although the rating decision listed both C&P examinations in evidence).  The VA additionally rated the right knee surgical scars at 0% under the 7804 scar code.  The Board considered if a higher rating under 5261 could be recommended for the limitation of extension evidenced in the C&P examinations.  Members agreed, however, that all of the service evidence and the VA orthopedic examination fairly proximate to separation outweighed the probative value of the C&P evidence; thus, the preponderance of evidence did not support a rating higher than 10% under 5261.  The Board also considered if a separate rating for instability could be recommended.  The pre-separation C&P documented the use of a brace and some mild anterior stability by that examiner; but, this was not corroborated by the rest of the evidence and furthermore there was MRI confirmation of intact ligaments.  Members thus agreed that there was thus insufficient evidence to support additional rating of instability; and, likewise agreed that there was no evidence of persistent effusion with locking, or fracture with malunion or non-union, to support a rating higher than 10% under any other applicable code.  There was no functional impairment linked to fitness to justify service rating of the surgical scars.  After due deliberation, considering all of the evidence and conceding VASRD §4.3 (reasonable doubt), the Board recommends a 10% rating for the right knee condition; proposing code 5099-5014 (osteomalacia) for its clinical compatibility.

BOARD FINDINGS:  In the matter of the right knee condition, the Board unanimously recommends a disability rating of 10%, coded 5099-5014 IAW VASRD §4.71a.  There were no other conditions within the Board’s scope of review for consideration.  The Board recommends that the CI’s prior determination be modified as follows, effective as of the date of the prior medical separation:  

CONDITION	VASRD CODE	PERMANENT RATING	
Osteochondritis with Surgical Residuals, Right Knee	5099-5014	10%	
COMBINED	10%	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20140414, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

SAMR-RB

JUL 19 2016

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

SUBJECT: Department of Defense Physical Disability Board of Review Recommendation
for XXXXXXXXXXXXXXXXXX, AR20160007635 (PD201402671)

1 , 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, accept the Board's recommendation to modify the individual's disability rating to 10% without re-characterization of the individual's separation, This decision is final.

2. I direct that all the Department of the Army records of the individual concerned be corrected accordingly no later than 120 days from the date of this memorandum.

3. I request that a copy of the corrections and any related correspondence be provided to the individual concerned, counsel (if any), any Members of Congress who have shown interest, and to the Army Review Boards Agency with a copy of this memorandum without enclosures.

BY ORDER OF THE SECRETARY OF THE ARMY:

CF:
( ) DoD PDBR
( ) DVA