RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2015-00325
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20060714

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

CI CONTENTION:  In addition to his right knee, the CI contended for PTSD, TBI, double vision, residual scars, tinnitus, chronic lower back strain, and depressive disorder.  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 - 20060613	VARD - 20070123	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Right Knee Pain	5099-5003	0%	Chronic PFS…with Residual Scars	5260	10%	20060925	
Recurrent Low Back Pain	Not Unfitting	Chronic Thoracolumbar Strain with Scoliosis	5237	NSC	20060925	
Elevated Blood Pressure						
COMBINED RATING:  0%	COMBINED RATING OF ALL VA CONDITIONS:  20%	

ANALYSIS SUMMARY:  

Chronic Right Knee Pain.  According to service treatment records (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI underwent arthroscopic surgery for a plica excision on the right knee in November 2005.  At the time of the arthroscopy, no other abnormalities were noted.  At the 07 December 2005 orthopedic clinic examination, 7 months prior to separation, range of motion (ROM) was 125 degrees flexion (normal 140) and 0 degrees extension (normal).  Minimal swelling and mild patellar tightness were noted.  Following surgery further treatment did not result in improvement sufficient to allow unrestricted duty.  The MEB forwarded “chronic right knee pain/patellofemoral dysfunction” for PEB adjudication.  At the MEB examination in March 2006, 4 months prior to separation, the CI reported a painful, locking right knee.  Physical examination showed decreased flexion in the right knee with trace effusion.  Tenderness was noted around the medial border of the patella.

At the MEB NARSUM examination on 10 May 2006, 2 months prior to separation, the CI noted that excessive walking and carrying of heavy weights significantly worsened the right knee pain.  Physical examination showed ROM flexion of 130 degrees and extension to 0 degrees.  There were no recorded tests for stability.

At the 25 September 2006 General Medical VA Compensation and Pension (C&P) evaluation, performed 2 months after separation, the CI reported pain, weakness and swelling in the right knee most days.  There was no reported instability or giving way.  The CI experienced no flares.  The CI did report locking with extension.  The CI wore a brace most of the time which allowed him to do most daily activities.  He was employed as a detention officer for a county Sheriff’s office which required sitting most of the time, with short periods of walking and standing; and this did not affect his employment.  He could do household chores and limited shopping.  He did not participate in sports but did exercise and could perform military calisthenics.  Physical examination showed a normal posture and gait.  The CI wore a knee brace but did not use any other ambulatory aids.  The right knee evidenced pre-patellar swelling consistent with bursitis, with tenderness to palpation over the patella.  There was a positive grind test.  No crepitus was noted other than a slight pop with repetitive ROM.  Extension was 0 degrees with pain at full extension.  Flexion was 134 degrees with pain starting at 100 degrees.  Repetitive motion decreased flexion by 4 degrees to 130 degrees, and this was attributed to pain.  All tests for instability were negative.  The right lower extremity was neurovascularly intact.  Right knee X-rays were normal.

The Board directed attention to its rating recommendation based on the above evidence.  The PEB rated the chronic right knee pain condition 0%, analogously coded 5099-5003 (arthritis, degenerative), citing full range of knee motion without instability.  The VA rated the chronic right knee pain condition 10% coded 5260 (leg, limitation of flexion of), based on the VA C&P examination 2 months after separation, citing functional limitations due to pain.  There was no limitation of flexion or extension that supported a rating under the VASRD diagnostic codes for limitation of motion (5260 or 5261).  The examinations proximate to separation did not demonstrate the presence of ligamentous instability or laxity (5257), and there was no history of dislocated meniscus or loose body causing frequent locking with recurrent effusions (5258) or history of surgery to remove a meniscus (5259) to support a rating under the respective codes.  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).  However, there was evidence of painful motion with functional loss supporting a 10% rating (based on §4.59, §4.40 and §4.45).  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 chronic right knee pain condition, coded 5099-5003.  

Contended PEB Condition:  Recurrent Low Back Pain and Elevated Blood Pressure.  The Board’s main charge is to assess the fairness of the PEB’s determination that the contended conditions were not unfitting.  The contended conditions were 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 either of the conditions 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 determinations for the contended conditions and so no additional disability ratings are recommended.  

BOARD FINDINGS:  In the matter of the chronic right knee pain condition, the Board unanimously or majority recommends a disability rating of 10%, coded 5099-5003 IAW VASRD §4.71a.  In the matters of the contended recurrent low back pain and elevated blood pressure conditions, the Board unanimously or majority 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 the prior medical separation:  

CONDITION	VASRD CODE	PERMANENT RATING	
Chronic Right Knee Pain	5099-5003	10%	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20150519, w/atchs
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

21 DEC 2016

SUBJECT:  Department of Defense Physical Disability Board of Review Recommendation for 
XXXXXXXXXXXXXXXXXX, AR20160018680 (PD201500325)

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