RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2014-04291
BRANCH OF SERVICE:  Army	SEPARATION DATE:  20090215

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E-4 (Health Care Specialist) medically separated for a right knee condition.  The condition could not be adequately rehabilitated to meet the physical requirements of her Military Occupational Specialty (MOS).  She was issued a permanent L3 profile and referred for a Medical Evaluation Board (MEB).  The “chronic right knee pain” was forwarded to the Physical Evaluation Board (PEB) IAW AR 40-501.  No other conditions were submitted by the MEB.  The Informal PEB adjudicated “chronic right knee pain” as unfitting, rated 10%, citing application of the Veterans Affairs Schedule for Rating Disabilities (VASRD).  The CI made no appeals and was medically separated.  

CI CONTENTION:  The CI requested that the Board consider all conditions.  The complete submission is at Exhibit A. 

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 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 20081103	VA* - (~4 Mos. Post-Separation)  	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Right Knee Pain	5099-5003	10%	PFS, Right Knee	5299-5261	10%	20090623	
Other MEB/PEB Conditions x 0 (Not In Scope)	Other x 10 	
RATING:  10%	RATING:  40%	
*Derived from VA Rating Decision (VARD) dated 20090928 (most proximate to date of separation (DOS)).  

ANALYSIS SUMMARY:  

Chronic Right Knee Pain Condition.  The record shows that the CI initially injured her knees prior to accession, but had recurrent pain beginning in basic training.  She was able to complete training and deploy, but her symptoms continued despite duty modifications, physical therapy (PT), and medications.  An MRI on 14 September 2007 was remarkable for a bone bruise.  A trial of injections gave temporary relief.  On 14 February 2008, she had surgical removal of redundant tissue in the right knee.  Her knee was noted to be stable and the menisci intact.  She reinjured her knee during rehabilitation and was thought to have a possible lateral meniscal tear (the internal knee cartilage cushion on the outside of the knee), but an MRI excluded this.  The narrative summary (NARSUM) was dated 24 June 2008 and noted the above.  At the VA Compensation and Pension (C&P) examination performed on 23 June 2009, 4 months after separation, the CI reported subjective instability and locking in both knees.  She denied incapacitation or the use of assistive devices.  On examination, her gait was normal, but the knee appeared somewhat swollen.  The range-of-motion (ROM) was painful and reduced (below), but improved with repetition.  The knee was stable.  No meniscal signs were recorded.  Tenderness was present to palpation.  An X-ray done that day was normal.  The goniometric ROM evaluations in evidence which the Board weighed in arriving at its rating recommendation, with documentation of additional ratable criteria, are summarized in the chart below.

Right Knee ROM
(Degrees)	PT ~06 Mos. Pre-Sep	PT ~5 Mos. Pre-Sep	VA C&P ~4 Mos. Post-Sep	
Flexion (140 Normal)	117 (clinic) 130 (MEB)	140	110	
Extension (0 Normal)	-5	0	0	
Comment	6 months post op; Painful motion	Painful motion not documented	Painful motion	
§4.71a Rating	10%	0%	10%	

The Board directed its attention to its rating recommendation based on the above evidence.  The PEB and VA both rated the knee at 10%, coded 5099-5003 (analogous to degenerative arthritis) and 5299-5261 (limitation of extension), respectively.  The ROM was not compensable on any examination proximate to separation.  Painful motion supports a 10% rating.  Instability was not present and, therefore, an additional rating is not supported.  The Board found no route to a rating higher than the 10% rating adjudicated by both the PEB and VA.  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.  

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 right 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.  

RECOMMENDATION:  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 20141013, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record
SAMR-RB

SUBJECT: Department of Defense Physical Disability Board of Review Recommendation
for XXXXXXXXXX, AR20160005179 (PD201404291)

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
( ) OVA