RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXXXX	CASE:  PD-2014-02795
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20060512

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E5, Power Generator Equipment Repairer, medically separated for “chronic right knee pain without neurologic abnormality” with a disability rating of 0%.  

CI CONTENTION:  The CI contends “His rating was downgraded from 10% to 0%.  His wrist condition, hearing loss, and heart attack were denied and his degenerative change to his right knee was only rated at 10%.”  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 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 - 20060404	VARD - 20070129	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Right Knee Pain…	5099-5003	0%	Degenerative Changes, Right Knee (Claimed as Pain, Medial Meniscus Tear, and Osteoarthritis	5010-5260	10%	20061025	
COMBINED RATING:  0%	COMBINED RATING OF ALL VA CONDITIONS:  40%	

ANALYSIS SUMMARY:  

Chronic Right Knee Pain without Neurologic Abnormality.  According to service treatment records and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s right knee condition began in February 2005 during physical training without specific injury.  Radiographic studies 25 April 2005 showed minimal degenerative changes with minimal tibial spine spurring.  There was mild narrowing of the medical compartment.  Osteopenia was present (bone density lower than normal).  Radiographic studies 16 May 2005 showed medial joint widths narrowing indicating cartilaginous degeneration.  There was medium volume effusion.  Magnetic Resonance Imaging (MRI) studies 9 August 2005 showed degeneration and an oblique tear involving the posterior horn of the right medial meniscus.  There was small lateral joint effusion.  There was mild degeneration of the posterior horn of the right lateral meniscus.  The CI underwent arthroscopy and meniscal debridement without complication of the right knee on 16 September 2005.  Following surgery further treatment did not result in improvement sufficient to allow unrestricted duty.  The MEB forwarded “chronic right knee pain” for PEB adjudication.  The range-of-motion (ROM) evaluations in evidence which the Board weighed in arriving at its rating recommendation, with documentation of additional ratable criteria, are summarized in the chart below. 

Right Knee ROM
(Degrees)	PT ~8 Mo. Pre-Sep
	MEB ~2 Mo. Pre-Sep
	VA C&P ~5 Mo. Post-Sep
	
Flexion (140 Normal)	“AROM full”	0-135	120	
Extension (0 Normal)	“	-	5	
Comment	Tender to palpation along incisions/strength 5/5 	Moderate effusion/tender to palpation/no crepitus	Tenderness on medial tibial plateau/locking pain and crepitus present	
§4.71a Rating	0%	10%	10%	

At the MEB examination (recorded on DD Forms 2807 and 2808) dated 26 January 2006, 4 months prior to separation, the CI reported constant pain and persistent swelling with occasional popping sensation since his injury.  Physical examination showed well-healed surgical scars consistent with arthroscopy.  There was moderate effusion (swelling) and tenderness to palpation of the medial and lateral joint lines.  The ROM was mildly limited in flexion as recorded in the chart.  There was no ligamentous instability was negative.  The examiner opined that the knee pain was “related to degenerative changes of a chronic nature.”  At the VA Compensation and Pension (C&P) examination on 25 October 2006 (5 months after separation), the CI reported constant knee pain which was aching in nature.  The pain was 3/10 rising to 10/10 at its worst.  The pain was aggravated by physical activity and relieved by rest and medication (Motrin and Percocet).  He reported morning stiffness, swelling with prolonged use, periodical “giving way,” and locking after being in one position for an extended period of time.  Physical examination showed tenderness of the medial tibial plateau.  There was “locking pain and crepitus.”  The ROM was limited in flexion as recorded in the chart.  Examination tests for ligamentous instability and meniscus pathology were negative.  There were no signs of an effusion or edema. 

The Board directed attention to its rating recommendation based on the above evidence.  The PEB rated the right knee condition 0%, coded 5099-5003 (arthritis, degenerative [osteoarthritis]), citing painful motion applying the US Army Physical Disability Agency (USAPDA) pain policy.  The VA rated the right knee condition 10%, coded 5010-5260 (leg, limitation of flexion), citing limitation due to pain based on the post-separation C&P examination.  There was no limitation of flexion or extension that supported a rating under the VASRD diagnostic codes for limitation of motion (5260 or 5261).  The examinations proximate to separation did not demonstrate the presence of ligamentous instability or laxity (5257) for a rating under this code.  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).  However, there was evidence of painful motion with functional loss supporting a 10% rating (based on §4.59, §4.40 and §4.45.  After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the Board recommends a disability rating of 10% for the chronic right knee pain without neurologic abnormality condition, coded 5003.  
BOARD FINDINGS:  In the matter of the chronic right knee pain without neurologic abnormality condition, the Board unanimously recommends a disability rating of 10%, coded 5003 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 to medical separation:  

CONDITION	VASRD CODE	PERMANENT RATING	
Chronic Right Knee Pain without Neurologic Abnormality 	5003	10%	
COMBINED	10%	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20140526, 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-D0), 2900 Crystal Drive, Suite 300, Arlington, VA 22202-3557

SUBJECT: Department of Defense Physical Disability Board of Review Recommendation
for, AR20160007643 (PD201402795)

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