RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2015-00102
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20060711

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an National Guard E3, Basic Trainee, medically separated for “left knee pain,” with a disability rating of 10%.

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 - 20060621	VARD - 20061207	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Left Knee Pain 	5099-5003	10%	Left Knee Degenerative Joint Disease and Stress Fracture	5010-5260	10%	20061031	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  10%	

ANALYSIS SUMMARY:  

Left Knee Pain.  According to service treatment record and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s left knee condition began in November 2005 while sprinting.  Radiographic (X-ray) studies showed mild degenerative joint disease.  A bone scan on 22 November 2005 showed a left knee medial tibial plateau stress fracture.  The CI was treated with rest and physical therapy.  After continued left knee pain, a magnetic resonance imaging (MRI) accomplished 16 February 2006 showed “a stress fracture in the medial tibial plateau of the left knee and a posterior medial meniscus tear.”  The CI underwent left knee arthroscopic surgery with partial removal of the medial meniscus 21 March 2006.  After two months of pain medications and physical therapy the CI’s left knee pain could not be rehabilitated to the point of allowing unrestricted duty.  The MEB forwarded “left knee degenerative joint disease with pain and stress fracture and treated medial meniscus tear” for PEB adjudication.  

The MEB NARSUM examination on 17 May 2006, 2 months prior to separation, the CI reported that his left knee pain would “throb” at night and would hurt if he tried to run.  He reported a constant pain level of 5/10.  Physical examination showed an antalgic gait, swelling and deep tenderness over the anterior medial tibial plateau and range of motion (ROM) showed a flexion of 97 degrees (normal 140) and a normal extension of 0 degrees.  

At the 31 October 2006 VA Compensation and Pension (C&P) evaluation, performed 3 months after separation, the CI reported a constant dull aching pain and throbbing sensation deep inside his left knee.  Pain was elicited by physical activity and relieved by rest.  He also reported stiffness in the knee joint.  Physical examination showed normal posture and gait, no edema, effusion, weakness, tenderness, redness, heat, abnormal movement, or guarding in the left knee.  Left knee ROM showed a flexion of 110 degrees and a normal extension, limited by pain.  There was no instability of the left knee.  X-ray studies of the left knee accomplished in conjunction with the C&P evaluation were interpreted as normal.  

The Board directed attention to its rating recommendation based on the above evidence.  The PEB rated the left knee condition 10%, analogously coded 5003 (degenerative arthritis), citing chronic pain.  The VA also rated the left knee condition 10%, coded 5010-5260 (traumatic arthritis-leg limitation of flexion of), citing painful and limited motion.  There was no limitation of motion which supported a rating under the diagnostic codes for limitation of flexion or extension of the knee (5260, 5261). However, there was evidence of painful motion with functional loss supporting a 10% rating (based on §4.59, §4.40 and §4.45) as adjudicated by the PEB.  

The examinations proximate to separation did not demonstrate the presence of ligamentous instability or laxity to allow for additional ratings using code (5257), and there was no history of dislocated meniscus or loose body causing frequent locking with recurrent effusions (5258).  There was no fracture, non-union, or malunion of the femur or tibia to support consideration under the respective codes for knee impairment related to long bone conditions (5255, 5262).  There was therefore no VASRD §4.71a route to a rating higher than the 10% adjudicated by the PEB under any applicable code, and no grounds for additional rating based on the presence of instability.  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 pain condition.

Contended PEB Conditions:  Mild Iron Deficiency Anemia.  The Board’s main charge is to assess the fairness of the PEB’s determination that the contended condition was not unfitting.  The contended condition was not profiled or implicated in the commander’s statement or judged to fail retention standards.  There was no performance-based evidence from the record that the condition significantly interfered with satisfactory duty performance at separation.  After due deliberation, the Board concluded that there was insufficient cause to recommend a change in the PEB fitness determination for the contended condition and so no additional disability rating is recommended.  

BOARD FINDINGS:  In the matter of the left knee pain condition and IAW VASRD §4.71a, the Board unanimously recommends no change in the PEB adjudication.  In the matter of the contended mild iron deficiency anemia condition, the Board unanimously recommends no change from the PEB determination as not unfitting.  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 20140703, w/attachments
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 
XXXXXXXXXXXXXXXXXX, AR20160017950 (PD201500102)

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