RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX		CASE:  PD-2014-04076
BRANCH OF SERVICE:  Army 		 SEPARATION DATE:  20060920

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E1, Motor Transport Operator, medically separated for “chronic pain left knee..” with a disability rating of 10%.  

CI CONTENTION:  The CI requested consideration of 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 based upon a 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 - 20060629	VARD - 20071017  	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Pain Left Knee,...	5261	10%	Left Knee Injury Status Post Arthroscopic Surgery with Degenerative Joint Disease 	5010-5260	10%	20070914	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  0%	

ANALYSIS SUMMARY:  

Left Knee Pain.  The service treatment record (STR) and Medical Evaluation Board (MEB) narrative summary (NARSUM) noted onset of a traumatic left knee injury in August 2004 during pugil stick (basic) training with multiple re-injuries.  Arthroscopy in October 2005 showed synovitis, chondromalacia, and a medial plica (persistence of a congenital membrane in the knee joint that becomes inflamed).  The CI developed a subsequent joint infection and was treated with intravenous antibiotics and several arthroscopies (for irrigation and debridement) in November 2005.  Radiographic imaging in December 2005 (10 months pre-separation) documented a large joint effusion, synovitis, and medial meniscal tear.  Despite physical therapy and surgical interventions, the left 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 “joint pain after knee surgery” for PEB adjudication.  

At the NARSUM examination performed 26 May 2006 (5 months pre-separation), the examiner referred to physical therapy measurements (obtained on 22 May 2006) that documented a limp, extension lacking 10 degrees (normal 0) and flexion to 140 degrees (normal 140).  At the MEB examination (documented on DD Form 2808) dated 26 May 2006, the physical examination showed diffuse tenderness, with increased pain on valgus and varus (lateral and medial) stress, and no evidence of laxity.  At a primary care visit in June 2006 (3 months pre-separation), the examiner documented full range of motion (ROM), patellar crepitus and grind, and no evidence of effusion, laxity or instability.  

At a VA primary care visit dated 7 November 2006 (2 months post-separation), the CI reported bone pain, weakness and giving way.  Physical examination showed full ROM, with no tenderness, no swelling, and normal strength.  A VA Compensation and Pension (C&P) examination was performed on 14 September 2007 (12 months post-separation, however the examination was not in evidence.  The VA rating decision dated 17 October 2007 documented the September C&P physical examination findings.  There was a normal gait with no evidence of tenderness, weakness, guarding, effusion, crepitus, instability, or meniscal injury.  ROM was 0-120 degrees (normal 0-140) with pain.  

The Board directed attention to the rating recommendation based on the above evidence.  The PEB rated 10% for the “chronic pain, left knee, post-operative,” coded 5261 (leg, limitation of extension), citing mechanical limitations.  The VA rated 10% for “left knee injury status post arthroscopic surgery with degenerative joint disease,” retroactive to the date of separation, coded 5010-5260 (traumatic arthritis- leg limitation of flexion) and citing flexion of 120 degrees with painful motion.  

The Board considered the evidence for rating.  There was evidence of painful and limited motion (IAW VASRD §4.45, §4.59) in support of a 10% rating dual coded 5010-5260 (traumatic arthritis and leg limitation of flexion).  There was no documentation of extension limited to 15 degrees or flexion limited to 30 degrees for a 20% rating using coded 5261/5260.  There was radiographic imaging in December 2005 that documented a large joint effusion, synovitis, and medial meniscal tear.  Although there was imaging evidence of meniscal injury, there was no clinical evidence of meniscal tear/injury.  None of the examinations in evidence in the 9 months pre-separation documented frequent episodes of locking and effusion in to the joint for a higher rating under 5258.  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 left knee condition.  

BOARD FINDINGS:  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.  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 w/atchs
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 
, AR20160017814 (PD201404076)

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