RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2014-03546
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20050524

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E4, Motor Transport Operator, medically separated  for “chronic right knee pain secondary to chondromalacia (by MRI [magnetic resonance imaging]) and infrapatellar tendonitis, ” with a disability rating of 0%.  

CI CONTENTION:  The CI contends for a higher rating for his knee condition as well as multiple conditions not addressed during his disability evaluation process.  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 based on 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 - 20040304	VARD - 20110701	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Right Knee Pain Secondary to Chrondromalacia (by MRI) and Infrapatellar Tendonitis	5099-5003	0%	Right Knee Chondromalacia Infrapatellar Tendinitis	5257	0%	STR	
COMBINED RATING:  0%	COMBINED RATING OF ALL VA CONDITIONS:  0%	

ANALYSIS SUMMARY:  

Chronic Right Knee Pain.  According to service treatment records and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s right knee condition began in May 2002 during basic training after falling down stairs.  At a primary care clinic visit in August 2003, the physical examination showed tenderness of the medial joint line, with no effusion or ligamentous laxity.  Surgery was offered to the CI but he reasonably declined due to the uncertain outcome.  Despite further 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 a MEB.  The MEB forwarded “right knee chondromalacia patella and chronic right infrapatellar tendinitis” for PEB adjudication.  

At the MEB NARSUM dated 14 January 2004, 4 months prior to separation, the CI reported pain worsened by climbing, descending stairs, walking greater than a mile, running greater than 10 feet, climbing on and off equipment, carrying heavy objects and with prolonged flexion.  Physical examination noted a range of motion of 0-135 degrees (normal 0-140), and pain with patellar compression and over the patellar tendon.  All tests for instability or meniscal damage were negative.  Radiographic evaluations (X-ray) showed a normal knee; and an MRI reportedly showed evidence of thinning of cartilage at the knee joint (lateral femoral condyle and patella).  During the MEB examination (recorded on DD Forms 2807 and 2808) dated 20 January 2004, the CI reported “bad knees” with inability to run or climb on equipment.  Physical examination showed tenderness and effusion.  

The CI was scheduled for a VA Compensation and Pension (C&P) examination in June 2011, over 7 years after separation, however he failed to show for this examination.  No other VA examination proximate to separation was in evidence.  

The Board directed attention to the rating recommendation based on the above evidence.  The PEB rated the right knee condition 0%, coded 5099-5003 (arthritis, degenerative), citing full range of motion without joint instability.  The VA also rated the right knee condition 0%, coded 5257 (knee, other impairment of), citing the MEB findings of no significantly disabling residuals.  The VA’s rating was over 7 years after the CI’s date of separation and noted that a higher evaluation could not be assigned based on the lack of medical evidence.  

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 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).  However, there was radiographic evidence along with limitation of motion, effusion, and functional loss supporting a 10% rating (based on §4.59, §4.40 and §4.45) based upon the MEB examination and MEB NARSUM examination.  After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the Board recommended a disability rating of 10% for the right knee pain condition, coded 5099-5003.  

BOARD FINDINGS:  In the matter of the 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 medical separation:  

CONDITION	VASRD CODE	PERMANENT RATING	
Right Knee Pain	5099-5003	10%	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20140717, with attachments
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 XXXXXXXXXXXXXXXXXXXXX, AR20160011574 (PD201403546)

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.

			     

CF: 
(  ) DoD PDBR
(  ) DVA