RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2014-03981
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20081017

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty, E6, Cavalry Scout, medically separated for “arthritis, due to trauma (right knee pain),” with a disability rating of 10%.  

CI CONTENTION:  The CI requests the board 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 - 20080925	VARD - 20090520	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Arthritis, due to Trauma…	5010	10%	Right Knee Sprain with Complete Tear of Anterior Cruciate Ligaments Anterior…	5260	0%	STR	
Hypertension	Not Unfitting	Hypertension	7101	0%		
Hyperlipidemia 	Not Unfitting	Hyperlipidemia 	7399-7347	NSC		
Obesity	Not Compensable	No VA Placement	
COMBINED RATING:  0%	COMBINED RATING OF ALL VA CONDITIONS:  0%	

ANALYSIS SUMMARY:  

Arthritis, Due to Trauma, Right Knee.  According to service treatment records and the Medical Evaluation Board (MEB) narrative summary, the CI underwent right knee surgery in June 2007 for anterior cruciate ligament rupture and posterolateral corner rupture.  The injuries were associated with a motorcycle accident in March 2007.  Diagnostic imaging performed in April 2007 indicated full thickness tear of the lateral collateral ligament and likely avulsion of the popliteus tendon with significant effusion making further interpretation difficult.  

The CI underwent surgery in June 2007 with right knee ACL [anterior cruciate ligament] reconstruction and posterolateral corner repair.  The CI underwent physical therapy treatment for approximately 5 months and continued to have pain with motion as documented in repeated visits to his primary care provider and orthopedic clinic in January and February 2008 respectively.  Despite treatment, the CI’s knee condition could not be adequately rehabilitated to meet the physical requirements of the CI’s military specialty and was referred for an MEB.  The MEB forwarded “right knee pain” for PEB adjudication.  At the MEB examination dated 10 July 2008 (3 months prior to separation and over a year after surgery), the CI reported significant pain in his right knee both laterally and anteriorly.  The CI reported the pain was aggravated by running, going up stairs, and carrying heavy loads.  There were no complaints of locking or giving way.  He did not wear a knee brace nor was he taking medications for the pain.  The right knee physical exam showed a normal appearing knee with well healed surgery scars.  On examination the gait was normal.  There was “full range of motion of his (right) knee by goniometer.”  Patellofemoral crepitus was noted with slight lateral patellar tilt.  Examination tests for ligamentous instability and meniscus pathology were negative.  There was minimal tenderness and slight thigh atrophy.  His muscle strength was 5/5 and did not decrease with repetition.  Radiographic studies showed multiple screws in his right knee consistent with ACL and posterolateral reconstruction.  There was some bone spurring noted behind his knee cap and medial femoral condyle with only mild medial joint space narrowing (degenerative changes).  

The CI did not present for a VA Compensation and Pension (C&P) examination scheduled for 17 December 2008.  

The Board directed attention to its rating recommendation based on the above evidence.  The PEB rated the right knee condition 10% coded 5010 (arthritis, due to trauma).  The VA rated the right knee condition 0% coded 5260 (leg, limitation of flexion), citing missing VA exam evidence (“without current medical evidence”).  Remote VA rating based on additional service treatment records and VA exam in 2010 increased the right knee rating to 10% coded 5010-5260, citing painful after repetition.  The VA rating was effective back to the day after separation.  

There was no limitation of motion which attained a minimum 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) as adjudicated by the PEB.  The examinations proximate to separation did not demonstrate the presence of ligamentous instability or laxity (5257), frequent locking with effusions or any indication of dislocated meniscus or loose body (5258), 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.  

The knee scars did not interfere with wear of military gear and were not painful at the MEB exam.  Any contribution from the scars on ROM limitation was addressed above.  The Board adjudged that there was insufficient evidence of duty-limiting impairment from the knee scars to adjudge them separately unfitting.  The Board concluded therefore that the scars condition 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 concluded that there was insufficient cause to recommend a change in the PEB adjudication for the right knee condition.  

Contended PEB Conditions.  The Board’s main charge is to assess the fairness of the PEB’s determination that hypertension and hyperlipidemia conditions were not unfitting and that obesity was not compensable but could be administratively unfitting.  The Board’s threshold for countering fitness determinations requires a preponderance of evidence, but remains adherent to the DoDI 6040.44 “fair and equitable” standard.  The hypertension and hyperlipidemia conditions were not profiled or implicated in the commander’s statement and were not judged to fail retention standards.  The hypertension and hyperlipidemia conditions were reviewed and considered by the Board.  There was no performance based evidence from the record that either of these conditions significantly interfered with satisfactory duty performance.  Obesity is a condition not constituting a physical disability, IAW DoDI 1332.38.  Therefore, the Board has no basis for recommending it as unfitting.  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 fitness determination for the contended hypertension and hyperlipidemia conditions, or the not compensable determination for the obesity condition, and so no additional disability ratings are recommended.  

BOARD FINDINGS:  In the matter of the arthritis degenerative, right knee condition and IAW VASRD §4.71a, the Board unanimously recommends no change in the PEB adjudication.  In the matter of the contended hypertension, hyperlipidemia, and obesity conditions, the Board unanimously recommends no change from the PEB determinations as not unfitting and not compensable.  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 20140729, with attachments
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

SAMR-RB

JUL 28 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 XXXXXXXXXXXXXXXXXX, AR20160009440 (PD201403981)

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 (it 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