RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2014-02711
BRANCH OF SERVICE:  Army 	BOARD DATE:  20150508
SEPARATION DATE:  20080724

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E-4 (Multichannel Transmission Systems Operator-Maintainer) medically separated for a left knee condition.  The condition could not be adequately rehabilitated to meet the physical requirements of his Military Occupational Specialty or satisfy physical fitness standards.  He was issued a permanent L3 profile and referred for a Medical Evaluation Board (MEB).  The “chronic left knee pain secondary to degenerative joint disease (DJD) and chondromalacia of the patella; status post (s/p) left scope” was forwarded to the Physical Evaluation Board (PEB) IAW AR 40-501.  No other condition was submitted by the MEB.  The Informal PEB adjudicated “DJD, left knee, following patellar debridement and removal of loose body” as unfitting, rated 10% with application of the Veterans Affairs Schedule for Rating Disabilities (VASRD).  The CI made no appeals and was medically separated.

CI CONTENTION:  “Please consider all conditions.”

SCOPE OF REVIEW:  The Board’s scope of review is defined in DoDI 6040.44, Enclosure 3, paragraph 5.e.(2).  It is limited to those conditions determined by the 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/Naval 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 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:

IPEB – Dated 20080419	VA* - based on Service Treatment Records (STR)	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Left Knee Pain…	5003	10%	Left Knee Condition	5257	0%	STR	
Other MEB/PEB Conditions x 0 (Not In Scope)	Other x 3	
RATING:  10%	RATING:  0%	
*Derived from VA Rating Decision (VARD) dated 20130531 (most proximate to date of separation [DOS]).

ANALYSIS SUMMARY:  

Left Knee Condition.  The CI originally had a running-related injury to his left knee and diagnosed as a strain in August 2004.  Radiographic tests revealed degenerative changes and chondromalacia about the left knee.  Despite aggressive physical therapy (PT) and a variety of conservative treatment modalities, his knee pain progressed.  In October 2007, he underwent a left knee arthroscopy for debridement as well as to remove a loose body from the joint.  Post-operatively, he improved, but still had pain with activities.  He was referred for an MEB.  At the MEB examination on 27 February 2008 (5 months prior to separation), the CI reported the inability to carry heavy objects or stand for prolonged periods of time.  He noted increased pain with maneuvering stairs, kneeling, crawling, or squatting.  His physical examination noted decreased and painful motion, tenderness, and crepitus.  There was no evidence of instability.  His diagnosis remained left knee pain described as “slight” and “constant” and was the sole diagnosis listed on his permanent profile.   A remote VARD (proximate to separation) indicated an original 0% rating was due to “failure to report” for the C&P examination.  An Orthopedic clinical encounter dated 11 February 2008 (5 months prior to separation) noted full range-of-motion (ROM) with crepitus about the left knee.  There was a single goniometric ROM performed by PT on 21 March 2008 (4 months prior to separation) which the Board included in arriving at its rating recommendation.  The left knee ROM measurements recorded by PT on 21 March 2008 were flexion (130/130/130) and extension (0/0/0).  There was no comment as to the presence of painful motion with active ROM testing.

The Board directed attention to its rating recommendation based on the above evidence.  The PEB assigned a 10% rating under 5003 code (degenerative arthritis) citing limitation of motion.  Board members first acknowledged that the VA examination, closest to separation, would equate to a non-compensable rating, but the evidence of crepitus just a month earlier would reflect an indirect finding of painful motion and thus in support of a 10% rating IAW VASRD §4.59.  After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the Board concluded that there was insufficient cause to recommend a change in the PEB’s adjudication for the left knee condition.

BOARD FINDINGS:  IAW DoDI 6040.44, provisions of DoD or Military Department regulations or guidelines relied upon by the PEB will not be considered by the Board to the extent they were inconsistent with the VASRD in effect at the time of the adjudication.  The Board did not surmise from the record or PEB ruling in this case that any prerogatives outside the VASRD were exercised.  In the matter of the left knee condition 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.

RECOMMENDATION:  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 20140507, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

SAMR-RB						

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 XXXXXXXXXXXXXXXXXX, AR20150018837 (PD201402711)

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