RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXXX	CASE:  PD-2014-02914
BRANCH OF SERVICE:  Army	Separation Date:  20060404

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E-3 (Multichannel Transmission Operator-Maintainer) medically separated for chronic right knee pain rated 0%. 

CI CONTENTION:  “Please review all conditions.”

SCOPE OF REVIEW:  The Board’s scope of review is defined in DoDI 6040.44.  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 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 20060309	VA* - (~4 Mos. Post-Separation)	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Right Knee Pain…	5099-5003	0%	Right Knee Patellofemoral Syndrome	5299-5257	10%	20060807	
Other x 0 (Not In Scope)	Other x 3 	
RATING:  0%	RATING:  10%	
*Derived from VA Rating Decision (VARD) dated 20061121 (most proximate to date of separation (DOS)).  

ANALYSIS SUMMARY:   

Right Knee Condition.  The CI developed right knee pain in 2004 and reported pain worse with sitting and running.  He had tenderness to palpation (TTP) on patellar movement.  The Physical Therapist (PT) in October 2004 noted generalized joint laxity in the knees, TTP over the inferior pole of the patella, and patellar grind.  The right knee X-ray done in October 2005 was normal.  The CI was profiled L3 for right knee patellar tendonitis and had prior profiles and diagnosis of retropatellar pain syndrome.  

The MEB Narrative Summary (NARSUM) exam approximately 2 months prior to separation documented that despite intensive PT treatments, the CI continued with an inability to run and had pain under the kneecap with the walking PT test.  The MEB NARSUM physical exam findings are summarized in the chart below as well as the PT-performed range-of-motion (ROM) evaluations for the MEB.  

The VA Compensation and Pension (C&P) exam approximately 4 months after separation, the CI complained of pain up to 10/10 behind the kneecap with weakness and stiffness especially after sitting.  Pain was worse with prolonged walking or going up/down stairs, or with flare-ups.  He related he had “some giving way one to two times weekly, fatigability, and lack of endurance.”  He indicated that a supplied knee sleeve, used about once a month, increased the knee pain.  The VA C&P physical exam findings are summarized in the chart below.  The diagnosis was patellofemoral syndrome.  

There were ROM evaluations in evidence, with documentation of additional ratable criteria, which the Board weighed in arriving at its rating recommendation; as summarized in the chart below.  

Right Knee ROM
(Degrees)	MEB ~2 Mo. Pre-Sep	PT ~1 Mo. Pre-Sep	VA C&P ~4 Mo. Post-Sep	
Flexion (140 Normal)	“full range of motion from 0-120”	130/130/132	130	
Extension (0 Normal)		0/0/0	0	
Comments	Patellar grind +; TTP; 1-A Lachman; stable laterally with negative drawer 	ROM “not limited by pain; it was limited by soft tissue approximation;” goniometer used; passive ROMs 135/135/137	Painful ROM; gait normal; crepitus; TTP medial/lateral joint line; no instability	
§4.71a Rating	10%	0%-10%	10%	

The Board directed attention to its rating recommendation based on the above evidence.  The PEB coded the knee condition as analogous to 5003 (Arthritis, degenerative [hypertrophic or osteoarthritis]) and rated at 0%.  The VA coded the knee condition as analogous to 5257 (Knee, other impairment of) and rated at 10%.  The Board noted that the NARSUM “full ROM” was 20 degrees short of the VASRD normal and the exam documented a positive test for instability as well as patellar grind.  The PT exam, within 2 weeks of the NARSUM, indicated no pain to limit measurements, but active ROM was less than passive ROM and short of the VASRD normal.  The post-separation VA exam indicated painful motion (IAW VASRD §4.59) and crepitus.  The Board considered that the patellar grind and crepitus were indicative of indicative of “points of contact which are diseased” IAW VASRD §4.59 (painful motion) and that with consideration of VASRD §4.40 (functional loss) and §4.45 (the joints) warranted a disability rating of 10% for the right knee.  

There was scant evidence of instability to support dual rating of the knee and no current meniscal injury or more severely limited ROM for any additional or higher rating than 10% proximate to separation or any alternate coding.  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 right 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 right knee condition, the Board unanimously recommends a disability rating of 10%, coded 5099-5003 IAW VASRD §4.71a.  There were no other conditions within the Board’s scope of review for consideration.  
RECOMMENDATION:  The Board recommends that the CI’s prior determination be modified as follows, effective as of the date of his prior medical separation:  

UNFITTING CONDITION	VASRD CODE	RATING	
Chronic Right Knee Pain	5099-5003	10%	
COMBINED	10%	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20140430 w/atchs
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 XXXXXXXXXXXXXXXXXXXX, AR20160004998 (PD201402914)

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