RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXXXX	CASE:  PD-2014-03274
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20090527

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an E4, Infantryman, medically separated for “arthritis, degenerative, right knee…,” rated 10%.

CI CONTENTION:  The CI requests that all conditions be considered.  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 - 20090310	VARD - 20090804	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Arthritis…Right Knee…	5003-5261	10%	Right Knee…Chondromalacia	5260	10%	20080929	
Tension Headaches	Not Unfitting 	Headaches	8099-8100	NSC		
GERD		GERD	Deferred	
Mild Sensorineural Hearing Loss		Right Ear Hearing Loss	6100	10%	20090721	
		Left Ear Hearing Loss	6100	NSC		
Depression		Mood Disorder Claimed as Depression with Anxiety	9435	10%	20090629	
Anxiety						
Non-Cardiac Chest Pain		No VA Placement	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  60%	

ANALYSIS SUMMARY:  

Arthritis, Degenerative, Right Knee.  According to service treatment records and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s right knee condition began in July 2007 when he twisted the knee during a training mission.  Diagnostic imaging studies (MRI) in August 2007 revealed evidence of chondromalacia patella (softening and deterioration of the cartilage under the knee cap).  There was no surgical indication.  Despite conservative treatment, the right knee condition could not be adequately rehabilitated to meet the physical requirements of the CI’s military specialty and the CI was referred for MEB.  The MEB forwarded “chronic right knee pain due to chondromalacia patella and moderate to severe osteoarthritis” for PEB adjudication.

At the time of the orthopedic appointment on 20 August 2008 (9 months prior to separation), the CI reported knee pain with grinding and giving way.  Examination testing for ligamentous laxity was negative.  Examination revealed tenderness and effusion.  The VA Compensation and Pension (C&P) examination on 29 September 2008 recorded complaints of knee pain, popping, and decreased range of motion (ROM), with flexion of 110 degrees (normal 140), aggravated or precipitated by prolonged standing, running, marching, or wearing boots.  Physical exam showed a normal gait and no knee brace was being used by the CI.  An MRI indicated cartilage defect in the right knee with an excess collection of fluid in the knee.  The MEB NARSUM dated 15 December 2008 (5 months prior to separation), noted complaints of pain rated 1-2/10 increasing to 5-6/10 with prolonged sitting, walking, standing, and bending of the knee.  Navigating stairs increased the pain to 8-9/10.  The CI reported an inability to run, ruck, march, or carry a fighting load.  Examination noted a slight limp favoring the right leg.  The right knee was tender, with pain elicited on flexion and extension.  Audible and palpable crepitus (popping or grinding noise and/or sensation) were also noted on flexion and extension.  At the physical therapy (PT) clinic visit on 16 April 2010, 11 months after separation, the CI reported constant knee pain generally rated at 1-2/10 with flares to 9/10; at the time of the examination the pain was 6/10.  Limited ROM of flexion of 120 degrees was recorded.  Pain was increased with walking, weight bearing, and going down steps.  Physical examination reported a moderate antalgic gait, painful motion and negative McMurray testing.  

The Board directed attention to its rating recommendation based on the above evidence.  The PEB rated the right knee condition 10%, coded 5003-5261 (degenerative arthritis-limitation of leg extension) citing limitation of motion of one major joint due to pain.  The VA rated the right knee condition 10% coded 5260 (limitation of leg flexion), citing painful motion.  There was no limitation of motion which supported a rating under the diagnostic codes for limitation of flexion or extension (5260, 5261).  However, there was evidence of painful motion with functional loss supporting a 10% rating (based on §4.59, §4.40 and §4.45).  The examinations proximate to separation did not demonstrate the presence of ligamentous instability or laxity (5257), and there was no history of dislocated meniscus or loose body causing frequent locking with recurrent effusions (5258), or history of surgery to remove a meniscus (5259) to support a rating under the respective codes.  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).  There is therefore no VASRD §4.71a route to a rating higher than the 10% adjudicated by the PEB under any applicable code, and no grounds for additional rating based on the presence of instability.  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 adjudication for the degenerative arthritis of the right knee. 

Contended PEB Conditions:  Tension Headaches, Gastroesophogeal Reflux Disease (GERD), Mild Sensorineural Hearing Loss, Depression, Anxiety, and Non-Cardiac Chest Pain.  The Board’s main charge is to assess the fairness of the PEB’s determination that the contended conditions were not unfitting.  None of the conditions were profiled or implicated in the commander’s statement or judged to fail retention standards.  There was no performance-based evidence from the record that any of the conditions significantly interfered with satisfactory duty performance at separation.  After due deliberation, the Board concluded that there was insufficient cause to recommend a change in the PEB fitness determination for any of the contended conditions and so no additional disability ratings are recommended.  
BOARD FINDINGS:  In the matter of the degenerative arthritis of the right knee and IAW VASRD §4.71a, the Board unanimously recommends no change in the PEB adjudication.  In the matter of the contended tension headaches, GERD, mild sensorineural hearing loss, depression, anxiety, and non-cardiac chest pain, the Board unanimously recommends no change from the PEB determinations as not unfitting.  There were no other conditions within the Board’s scope of review for consideration.  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 20140708, 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 XXXXXXXXXXXXXXXXXXXXX AR20160014198 (PD201403274)

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