RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2014-03683
BRANCH OF SERVICE:  Army	BOARD DATE:  20150626
SEPARATION DATE:  20090922

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E-2 (M-1 Armor Crewman Trainee) medically separated for a left knee condition.  The left knee condition could not be adequately rehabilitated to meet the physical requirements of his Military Occupational Specialty or satisfy physical fitness standards.  He was issued a permanent L3 profile and referred for a Medical Evaluation Board (MEB).  “Left knee patellofemoral instability” was forwarded to the Physical Evaluation Board (PEB) IAW AR 40-501.  No other conditions were submitted by the MEB.  The Informal PEB adjudicated “left knee pain” as unfitting, rated 10%, citing criteria of the Veterans Affairs Schedule for Rating Disabilities (VASRD).  The CI made no appeals and was medically separated.

CI CONTENTION:  “Please consider all conditions.”

SCOPE OF REVIEW:  The Board’s scope of review is defined in DoDI 6040.44, Enclosure 3, paragraph 5.e.(2).  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/Naval 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 20090910	VA* - (~5 Mos. Post-Separation)  	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Left Knee Pain	5099-5003	10%	Degenerative Changes Left Knee	5003-5260	10%	20100302	
Other MEB/PEB Conditions x 0 (Not In Scope)	Other x 1 	
RATING:  10%	RATING:  10%	
*Derived from VA Rating Decision (VARD) dated 20100327 (most proximate to date of separation [DOS]).

ANALYSIS SUMMARY:

Left Knee Condition.  Many of the service treatment records are not in evidence, but are summarized by the treating orthopedic surgeon in his assessment dated 22 July 2009.  While preparing for his GED and prior to beginning basic training, the CI twisted his knee while running and subsequently reinjured it during a field training exercise.  A magnetic resonance imaging was normal by report.  Management with medications, duty restriction, and physical therapy was unsuccessful and he underwent surgery on 13 April 2009 to correct a patellar misalignment.  Following surgery, he remained symptomatic and was limited to walking ¼ mile or standing 10 minutes before significant discomfort.  On examination, he walked, sat, and stood well (without significant discomfort).  There was an audible pop with extension, but the knee was stable and without effusion.  An apprehension sign was absent.  The narrative summary dated 12 August 2009, 6 weeks prior to separation, noted ongoing pain despite rehabilitation.  On examination he had a limp.  The range-of-motion (ROM) of the left knee was better than the right side, but neither met VA normal values for flexion.  Flexion was painful at the extreme limit.  There was some laxity of the collateral ligaments (along the sides of the knee), but with a solid endpoint.  The internal ligaments were stable on testing and signs of meniscal irritation absent.  Atrophy of the quadriceps muscle was present.  Mild apprehension was present.  At the VA Compensation and Pension examination performed on 2 March 2010, 5 months after separation, the CI reported that his knee continued to “pop” and that his pain had gotten progressively worse.  Going up and down stairs was painful; however, he was able to live on the third floor in a building without an elevator.  He rarely took medications for the pain.  He showed a painful gait, but used no assistive device.  On examination, crepitus, tenderness, and guarding were present.  The knee was stable without abnormalities of the menisci or kneecap.  Flexion was reduced to 132 degrees, but greater than the asymptomatic right knee.  DeLuca criteria were negative.  An X-ray showed minimal narrowing of the medial (inside) compartment (space between the bones).  The goniometric 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.

Left Knee ROM
(Degrees)	Ortho ~1 Mo. Pre-Sep	MEB ~1 Mo. Pre-Sep	VA C&P ~5 Mos. Post-Sep	
Flexion (140 Normal)	137	135, 138, 137	132	
Extension (0 Normal)	6	0, 0, 0	0	
Comment	Right side 6-135	Right knee 0-130	Painful motion; Right knee 0-128	

The Board directed attention to its rating recommendation based on the above evidence.  The PEB and VA both rated the left knee condition at 10%, coded 5099-5003 (analogous to degenerative arthritis) and 5003-5260 (degenerative arthritis and limitation of flexion), respectively.  The limitation in motion is not compensable and, even so, the ROM exceeded the unaffected right side.  The knee was stable on examination and without evidence for meniscal injury.  However, motion was painful on multiple examinations; this supports a rating of 10% IAW VASRD §4.59 (painful motion).  The Board found no route to a higher rating.  After due deliberation in consideration of the preponderance of the evidence, the Board concluded that there was insufficient cause to recommend a change in the PEB adjudication for the left knee pain 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 left knee condition and IAW VASRD §4.71a, the Board unanimously recommends no change in the PEB adjudication.  There were no other conditions within the Board’s scope of review for consideration.

RECOMMENDATION:  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 20140719, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

SAMR-RB	0 6 JUL 2016

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 XXXXXXXXXX, AR20160003193 (PD201403683)

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: