RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXXXX	CASE:  PD-2014-04232
BRANCH OF SERVICE:  Army	SEPARATION DATE:  20040414

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E4, Generator Mechanic, medically separated for “pain in right knee,” with a disability rating of 0%.  

CI CONTENTION:  “Please 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 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 – 20040102	VARD - 20040505   	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Pain Right Knee	5099-5003	0%	Grade 3-4 Chondromalacia, R Knee	5099-5014	10%	20040311	
			Right Knee Instability	5257	10%		
COMBINED RATING:  0%	COMBINED RATING OF ALL VA CONDITIONS:  20%	

ANALYSIS SUMMARY:  

Pain Right Knee.  According to the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI injured his right knee in November 2000 while in basic training.  He was able to complete training, but his pain persisted.  In July 2003, he underwent arthroscopic surgery and was found to have chondromalacia (degeneration of the cartilage) of the lining of the joint which was treated with micro-fracturing (an attempt to regenerate the cartilage by increasing the blood flow to it).  Despite this, he was unable to meet full duty requirements and referred for an MEB.  The MEB forwarded Grade III IV chondromalacia of the patella (kneecap) and trochlear groove (the part of the femur which contacts the patella) for PEB adjudication.  At the MEB examination (recorded on DD Forms 2807 and 2808) dated 8 October 2003 the CI reported right knee arthritis.  On the examination, he was noted to have atrophy of the quadriceps muscle.  The MEB NARSUM orthopedic examination on 12 November 2003, 5 months prior to separation, noted complaints of knee pain with physical fitness training and ruck marching.  On examination, the range of motion (ROM) was full but painful.  The knee was stable in all planes.  A patellar grind was positive, consistent with the diagnosis.  No other clinical records prior to separation were in evidence.  At the VA Compensation and Pension (C&P) evaluation, performed on 11 March 2004, 1 month before separation, the CI reported continued pain in the right knee.  On examination, he had a normal gait and did not use an assistive device.  The ROM was full and the knee tender.  The knee was stable other than lateral and medial laxity when the knee was flexed at 30 degrees.  It was stable at 0 degrees.  Signs of meniscal irritation (the meniscus is an internal cartilage cushion) were absent as were signs of anterior or posterior instability.  Following separation, there are no additional records until 20 March 2006, almost 2 years after separation.  In separate visits in primary care and orthopedics that day, the knee was noted to be stable with good ROM.  A second joints C&P was accomplished on 19 July 2006.  Flexion was reduced to 125 degrees (140 is normal), but pain free.  Tenderness was present though.  On this examination, there was no lateral or medial ligamentous laxity which the initial C&P documented; however, this examination documented trace laxity of a ligament providing anterior and posterior stability which had not been present on the initial C&P.  

The Board directed attention to its rating recommendation based on the above evidence.  The PEB rated the right knee condition 0%, coded 5099-5003 (analogous to degenerative arthritis), noting that there was no ligamentous laxity (the knee was stable).  The VA also rated the knee condition 10% for chondromalacia, coded 5099-5014 (analogous to osteomalacia) based on the VA C&P examination 1 month before separation noting tenderness.  It also rated the right knee for instability at 10%, coded 5257 (other impairment of the knee including lateral instability).  The MEB examination was less proximate to separation than the VA C&P; however, it was accomplished by an orthopedist which accords it a higher probative value.  In addition, there were three examinations after separation although approximately 2 years later.  Considering the totality of evidence, 4/5 examinations showed that the lateral and medial collateral ligaments were stable and a different set of examinations showed 4/5 demonstrating stability in the anterior and posterior direction.  The preponderance of evidence does not support the presence of instability at separation.  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 pain condition.  

BOARD FINDINGS:  In the matter of the right knee pain 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 20140521, 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 XXXXXXXXXXXXXXXXXXXXX AR20160013850 (PD201404232)

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