RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME: XXXXXXXXXXXXXXXXXX	CASE:  PD-2014-04252
BRANCH OF SERVICE:  Army	BOARD DATE:  20150625
SEPARATION DATE:  20061103

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E-4 (Chemical Operations Specialist) medically separated for right knee pain.  The right knee condition could not be adequately rehabilitated to meet the physical requirements of her Military Occupational Specialty.  She was issued a permanent L3 profile and referred for a Medical Evaluation Board (MEB).  “Retropatellar pain syndrome” and “chondromalacia” were forwarded to the Physical Evaluation Board (PEB) IAW AR 40-501.  No other condition was submitted by the MEB.  The Informal PEB adjudicated “right knee pain” as unfitting, rated 0%, with likely application 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 20060913	VA* - Based on Service Treatment Record (STR)	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Right Knee Pain	5099-5003	0%	Right Knee, Chondromalacia	5299-5010	10%	STR	
Other MEB/PEB Conditions x 0 (Not In Scope)	Other x 3	
RATING:  0%	COMBINED RATING:  30%	
*Derived from VA Rating Decision (VARD) dated 20070122 (most proximate to date of separation [DOS]).

ANALYSIS SUMMARY:

Right Knee Pain.  In October 2004, this CI fell and injured her right knee.  She was treated with physical therapy (PT), activity modification and other conservative measures.  There was some improvement in her symptoms.  However, on subsequent occasions, she suffered re-injury of the right knee.  Over the course of several months, in spite of all treatment efforts, her right knee pain persisted and an MEB was initiated. The MEB narrative summary was dated 27 July 2006.  The CI reported that she was largely pain-free at rest, although there was some residual knee discomfort.  With exertion, her knee pain would increase to 7-8/10.  Sometimes the knee would swell up after heavy use and it would take several hours for the swelling to go away.  At the MEB physical examination (PE), both knees appeared normal and the gait was normal.  PE of the right knee revealed some tenderness to palpation (TTP), but no effusion or erythema (redness).  Minimal crepitus was noted under the patella.  Ligaments were stable.  Range-of-motion was measured by PT on 6 July 2006.  The right knee had 140 degrees of active flexion.  Magnetic resonance imaging was performed on 15 August 2006 and it showed mild chondromalacia.

The CI was medically separated from service on 3 November 2006.  Two months later, in January 2007, she had a VA Compensation and Pension (C&P) exam.  She reported that her right knee pain was 4-5/10.  About once per week the pain would increase to 8-9/10.  She was using Ibuprofen to help alleviate her knee pain.  On PE, she was in no acute distress and her gait was non-antalgic.  PE of the right knee revealed some TTP, but no effusion or erythema.  There was pain with patellar compression and pain with repetitive motion.  The ligaments were stable.  Right knee ROM was measured and is summarized in the chart below.

Right Knee ROM
(Degrees)	PT ~ 4 Mos. Pre-Sep
	VA C&P ~ 2 Mos. Post-Sep
	
Flexion (140 Normal)	140	90	
Extension (0 Normal)	-10	0	
Comment	no mention of pain with motion	painful motion	

The Board carefully reviewed the data from the examinations described above and directed attention to its rating recommendation based on the evidence in the record.  The January 2007 C&P exam was just 2 months after the DOS.  At that exam, the right knee ROM testing showed 90 degrees of active flexion.  Because of pain, her active flexion dropped to 85 degrees with repetitive motion.  The Board determined that the right knee condition was essentially non-compensable, based solely on the VASRD §4.71a diagnostic codes for limitation of knee motion (5260 and 5261).  However, IAW VASRD §4.59 (Painful motion), a 10% rating is warranted.  There was no path to a rating higher than 10%, since there was no evidence of ligamentous instability, subluxation, or other seriously disabling bone or joint abnormality.  After due deliberation, the Board determined that a 10% disability rating was appropriate.  Considering all of the evidence and mindful of VASRD §4.3 (Reasonable doubt), the Board recommends a 10% disability rating for the unfitting right knee 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 unfitting right knee condition, the Board unanimously recommends a disability rating of 10%, coded 5299-5260, IAW VASRD §4.59.  There were no other conditions within the Board’s scope of review for consideration.

RECOMMENDATION:  The Board, therefore, recommends that the CI’s prior determination be modified as follows, effective as of the date of her prior medical separation:

CONDITION	VASRD CODE	RATING	
Right Knee Pain 	5299-5260	10%	
RATING	10%	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20141021, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

SAMR-RB

06 JUL 2016

MEMORANDUM FOR Commander, US Army Physical Disability Agency
(AHRC-00), 2900 Crystal Drive, Suite 300, Arlington, VA 22202-3557

SUBJECT: Department of Defense Physical Disability Board of Review Recommendation
for XXXXXXXXXXXXXXXXXX, AR20160002834 (PD201404252)

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