RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2015-00261
BRANCH OF SERVICE:  ARMY 	SEPARATION DATE:  20070525

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

CI CONTENTION:  The applicant makes no specific contention in his application but simply listed conditions (right knee, high tibia osteotomy, carticel replacement, micro fracture lower back, degenerative disc disease, and PTSD).  His 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 - 20070416	VARD - 20071013  	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Right Knee Pain	5299-5257	0%	Scar, Right Knee	7805	0%	20070707	
			Post Traumatic Arthritis, Right Knee, with Chondromalacia and Patellofemoral Syndrome	5010	10%	20070707	
Right Knee Malalignment	Not Unfitting					
Anxiety Disorder	Not Unfitting 	Generalized Anxiety Disorder	9400	30%	20070707	
COMBINED RATING:  0%	COMBINED RATING OF ALL VA CONDITIONS:  40%	

ANALYSIS SUMMARY:  

Right Knee Pain.  According to service treatment records (STR), and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI fell and injured his right knee during deployment.  He failed conservative therapy and underwent right knee medial femoral condyle and trochlea surgery in May 2005.  After returning to duty, he sustained a repeat injury to his knee and required repeat surgery in March of 2006.  In May 2006, the CI underwent a 3rd surgery of the right knee.  Despite treatment, the right knee pain condition could not be adequately rehabilitated to meet the physical requirements of the CI’s military specialty and the CI was referred for an MEB.  The MEB forwarded “right knee pain” for PEB adjudication.  The MEB NARSUM was accomplished on 15 December 2006, 5 months before separation.  The CI reported he had pain and swelling of the right knee.  He noted his pain increased with activity and significantly improved while off duty; however, he was not capable of performing the duties of an infantryman due to his right knee condition.  On physical examination, he was noted to have well healed surgical incision, decreased light touch sensation lateral to the wound, and some tenderness.  The knee was ligamentous stable, and muscle tone was good.  At the MEB examination (recorded on DD Form 2808) dated 6 January 2007, 4 months prior to separation, the physical examination recorded right knee pain with flexion, pain with pressure, and pain with deep knee bending.  Physical therapy range of motion (ROM) for the MEB dated 8 February 2007, 3 months before separation documented flexion of 115 degrees (140 normal) on 3 trials, and normal extension of 0 degrees.  Painful motion was not documented.

At the 7 July 2007 VA Compensation and Pension (C&P) examination, performed 2 months after separation, the CI reported he had daily right knee pain and occasional swelling.  His pain worsened with walking, climbing and descending stairs, and standing.  Physical examination recorded ROM flexion to 115 degrees with pain, absence of crepitation, and no evidence of right knee instability.  The examiner noted some atrophy in the calf region on the right compared to the left; however, it was noted that the CI used no assistive device, had no additional functional impairment due to pain, weakness, fatigability, incoordination, or flare-ups.  There was no report of right knee giving way.  The examiner also noted that radiographs had demonstrated degenerative changes and arthritis.

The Board directed attention to its rating recommendation based on the above evidence.  The PEB rated the right knee condition 0% analogously coded 5299-5257 (knee, other impairment of), citing rating criteria under 5257 was not met nor was the condition ratable under the pain policy.  The VA rated the right knee condition 10% coded 5010 (traumatic arthritis), citing painful motion.  The recorded limitation of motion did not support a rating under the diagnostic codes for limitation of flexion or extension (5260, 5261).  However, there was evidence of painful motion supporting a 10% rating based on §4.59 as documented in the MEB physical examinations, 4 months before separation, and the VA C&P examination, 2 months after separation.  Evidence of ligamentous instability or laxity (5257) was not documented in the MEB or the VA C&P examinations, and there was no history of dislocated meniscus or loose body causing frequent locking with recurrent effusions (5258).  There were no additional codes to consider that would lead to the minimal disability compensation.  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, coded 5299-5003, IAW §4.59.  

Contended PEB Conditions:  Right Knee Malalignment and Anxiety Disorder.  The Board’s main charge is to assess the fairness of the PEB’s determination that the right knee malalignment and anxiety disorder conditions were not unfitting.  The PEB noted that the condition of right knee malalignment was not unfitting due to the MEB’s examiner assessment that the 6 degrees of valgus alignment was acceptable.  The right knee malalignment condition was not profiled or implicated in the commander’s statement and although, it was judged to fail retention standards, there was no performance based evidence that this condition had a negative impact on duty performance.  

The anxiety disorder condition had a S2 profile without mental health restrictions. The MEB psychiatrist noted that the CI was fit for duty and had a favorable prognosis.  The commander’s statement did not implicate any mental health condition, nor was the condition judged to fail retention standards.  

The contended conditions were reviewed and considered by the Board.  There was no performance based evidence from the record that the right knee malalignment and anxiety disorder conditions significantly interfered with satisfactory duty performance.  After due deliberation in consideration of the preponderance of the evidence, the Board concluded that there was insufficient cause to recommend a change in the PEB fitness determination for the  contended conditions and so no additional disability ratings are recommended.

BOARD FINDINGS:  In the matter of the right knee pain condition, the Board unanimously recommends a disability rating of 10%, coded 5299-5257 IAW VASRD §4.71a, and VASRD §4.59.  In the matter of the contended right knee malalignment and anxiety disorder 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 recommends that the CI’s prior determination be modified as follows, effective as of the date of his prior medical separation:  

CONDITION	VASRD CODE	RATING	
Right Knee Pain 	5299-5257	10%	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20150410, w/attachments
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 XXXXXXXXXXXXXXXXXX AR20160014246 (PD201500261)

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