RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2014-02924
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20060711

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

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 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 – 20060516	VARD - 20070615	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Right Knee Pain	5099-5003	0%	Residuals, S/P…Surgery, Right Knee	5260	10%	20060616	
			Tender Surgical Scar, Right Knee	7804	10%		
COMBINED RATING:  0%	COMBINED RATING OF ALL VA CONDITIONS:  80%	

ANALYSIS SUMMARY:  

Chronic Right Knee Pain.  According to service treatment records (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI underwent right knee surgery in April 2001 and again in July 2005 for a torn medial meniscus (torn knee cartilage).  Radiologic study in March 2006 documented a normal knee.  Despite continued treatment, the right knee pain could not be adequately rehabilitated to meet the physical requirements of her military specialty, so the CI was referred for MEB.  The MEB forwarded “right knee pain” for PEB adjudication.  

At a physical therapy appointment in April 2006, 3 months pre-separation, the examiner documented flexion to 125 degrees (normal 140) with full extension and no painful motion.  At the MEB NARSUM dated 20 April 2006, the CI reported intermittent knee pain brought on by climbing, prolonged standing, jumping, squatting, or running.  The examiner documented tenderness and pain with flexion, with normal gait, strength, and reflexes.  There was no evidence of ligamentous instability, meniscal injury, edema or effusion.  

At the VA Compensation and Pension (C&P) examination dated 16 June 2006 (1 month pre-separation), the examiner documented an inability to walk briskly due to knee pain, but a normal gait was recorded.  Flexion was to 110 degrees with pain and stiffness with 5 degrees of hyperextension.  “Moderate laxity” was noted.  There was no evidence of ligamentous tears, meniscal injury, edema or effusion.  There was tenderness to a scar on the knee but not to the arthroscopic knee surgery scars.  

The Board directed attention to the rating recommendation based on the above evidence.  The PEB rated the right knee condition 0% coded 5099-5003, (analogous to degenerative arthritis), with likely application of the US Army Physical Disability Pain Policy (rated for pain, moderate-intermittent).  The VA rated the right knee condition 10% coded 5260 (limitation of leg flexion), citing painful motion recorded at the pre-separation C&P examination.  The VA additionally rated the surgical scars at 10% under code 7804 (scars, unstable or painful).  

The Board considered the evidence for a higher than 0% rating.  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 significant ligamentous instability or laxity (5257) for a higher rating.  There was no evidence of a dislocated meniscus or loose body causing frequent locking with recurrent effusions (5258) for rating.  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 at the NARSUM and VA exams supporting a 10% rating (based on §4.59, §4.40 and §4.45).  

The Board cannot recommend disability rating for scars unless their presence imposes a direct functional limitation that renders the CI unfit.  The knee scars did not interfere with wear of military gear and were not painful at the MEB examination.  There was insufficient evidence of duty-limiting impairment from the knee scars, thus the Board concluded that the scars could not be recommended for additional disability rating.  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 pain, coded 5099-5003.  

BOARD FINDINGS:  In the matter of the chronic right knee pain 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.  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	5099-5003	10%	
COMBINED	10%	

The following documentary evidence was considered:
Exhibit A.  DD Form 294, dated 20140614, 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 XXX, Arlington, VA  22202-3557

SUBJECT:  Department of Defense Physical Disability Board of Review Recommendation for XXXXXXXXXXXXXXXXXX AR20160011088  (PD201402924)

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