RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2014-04082
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20060330

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was a Reserve E4, Construction Equipment Repairer, medically separated for “right knee injury,” with a disability rating of 0%.

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 - 20060224	VARD - 20061013	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Right Knee (Surgical Residuals)	5099-5003	0%	Traumatic Arthritis Right Knee	5010	10%	20060828	
Finger Laceration	Not Unfitting	Mallet Finger Left Index 	5229	10%	20060828	
Colonic Polyp	Not Unfitting 	No VA Placement	
COMBINED RATING:  0%	COMBINED RATING OF ALL VA CONDITIONS:  20%	

ANALYSIS SUMMARY:  

Right Knee.  According to the service treatment records (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI experienced an onset of right knee pain during training and underwent an arthroscopic meniscectomy in June 2004.  He recovered sufficiently to deploy to Afghanistan (August 2003 – July 2004).  The condition worsened during deployment and additional surgical interventions ensued in February 2005 (arthroscopic meniscectomy and chondroplasty) and December 2005 (arthroscopic debridement and chondroplasty).  The last operative note confirmed the absence of loose meniscus and stability to stress testing of all ligaments under anesthesia.  A post-operative MRI confirmed that all ligaments were intact and the absence of meniscal tears, but demonstrated degenerative changes and a possible loose body.  Post-operative STR and VA clinic notes soon after separation documented persistent gait disturbance, the intermittent presence of effusion, and the absence of instability; with no entries to the contrary and no indication of mechanical impingement (locking).  There was ample documentation of range of motion (ROM) which recorded flexion ranging from 105-125 degrees (normal 140, 45 for minimum 10%) and normal extension (0 degrees).  Post-operative treatment was unsuccessful at restoring full duty status and the CI was referred for MEB, which in turn forwarded “chondromalacia of the right knee” to the PEB.

The NARSUM examination on 11 August 2005, 9 months before separation and prior to last surgery, documented “daily pain” rated 6-7/10, aggravated by walking (100 yard tolerance) and climbing stairs.  The physical examination was deferred to the DD Form 2808 Report of Medical Examination, dated 25 July 2005, which recorded swelling and tenderness, a negative drawer sign, and guarding prohibiting further stress testing.  The most probative post-operative examination in evidence was a VA orthopedic note on 5 April 2006, 6 days after separation, which recorded an antalgic gait, tenderness, “no effusion,” stability to stress testing in all planes, flexion to 120 degrees, and normal extension.

At the VA Compensation and Pension (C&P) joint examination on 28 August 2006, 5 months after separation, the CI reported “cannot work ... pain all the time” and was using a cane and a brace.  VA evidence clarified that the CI was unable to return to his civilian job requiring manual labor.  The physical examination recorded an antalgic gait, tenderness, the presence of effusion, and stability to stress testing in all planes.  The ROM measurements were flexion to 110 degrees and “full” extension, specifying painful motion.

The Board directed attention to its rating recommendation based on the above evidence.  The PEB assigned a 0% rating under the analogous code 5003 (degenerative arthritis), citing ROM of 0-120 degrees and no laxity.  The VA assigned a 10% rating under code 5010 (arthritis due to trauma), citing painful motion from the C&P examination.  Board members agreed that painful motion was adequately supported by the evidence to achieve a minimum compensable rating of 10%.  Furthermore it was considered that, IAW VASRD §4.7 (higher of two evaluations), the application of code 5259 (cartilage, semilunar, removal of, symptomatic) was easily justified in this case, and provides for a 10% rating independently of any other criterion.  There was no ROM limitation in evidence meeting the minimum compensable under any code.  Multiple examinations and MRI confirmation of intact ligaments established the absence of objective instability as a pathway to additional rating under code 6257.  There was no evidence of objective impingement (locking) and insufficient evidence for a persistent effusion in justification of a 20% rating under code 5258.  Given that some fairly significant functional limitations were in evidence at separation (gait disturbance, assistive device, employment limitations), the Board considered analogous rating under 5299-5262 (tibia and fibula, impairment of) which confers ratings for contiguous knee disability: 10% for “slight,” 20% for “moderate” and 30% for “marked.”  Members agreed, however, that the analogous application of this fracture code (with no fracture present) was not sufficiently justified by VASRD §4.20 (analogous ratings) in this case which satisfies compensable criteria under more applicable joint codes.  After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the Board recommends a disability rating of 10% for the right knee condition, proposing code 5259 for its clinical compatibility.  

Contended PEB Conditions.  The Board’s main charge is to assess the fairness of the PEB’s determination that the left index finger and colonic polyp conditions were not unfitting.  The CI sustained a laceration of his left (non-dominant) index finger in 2004, requiring an extensor tendon repair, and was left with a mild flexion contracture.  Colonic polyps were removed during endoscopic evaluation of rectal bleeding in 2006, without recurrence of acute bleeding or other complications.  The finger condition was profiled U2 (not requiring MEB referral or generally associated with unfitting conditions) and the polyp condition was not profiled.  Neither condition was implicated in the commander’s statement nor judged to fail retention standards. 

There was no performance based evidence from the record that these conditions significantly interfered with satisfactory duty performance at separation.  After due deliberation, and in consideration of the preponderance of the evidence, the Board concluded that there was insufficient cause to recommend a change in the PEB fitness determinations for the left index finger and colonic polyp conditions; thus, they are not eligible for Service disability rating.  

BOARD FINDINGS:  In the matter of the right knee condition, the Board unanimously recommends a disability rating of 10%, coded 5259 IAW VASRD §4.71a.  In the matter of the contended left index finger and colonic polyp conditions, 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 the CI’s prior determination be modified as follows, effective as of the date of the prior medical separation:  

CONDITION	VASRD CODE	PERMANENT RATING	
Meniscal Injury and Chondromalacia with Surgical Residuals, Right Knee	5259	10%	

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

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 AR20160011828 (PD201404082)

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.

 BY ORDER OF THE SECRETARY OF THE ARMY:

CF: 
(  ) DoD PDBR
(  ) DVA