RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX		CASE:  PD-2015-00341
BRANCH OF SERVICE:  army		SEPARATION DATE:  20040106

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was a Reserve, E1, Health Care Specialist, medically separated for “right knee pain” with a disability rating of 0%.

CI CONTENTION:  The condition has not improved but has worsened over the years.  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 confined to 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 - Dated 20031125	VARD - 20040108	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Left Knee Pain	5099-5003	0%	Left Knee Injury	5299-5260	10%	STR*	
COMBINED RATING:  0%	COMBINED RATING FOR ALL VA CONDITIONS:  10%	
* Service treatment record

ANALYSIS SUMMARY:

Right Knee.  According to service treatment record (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI injured his left knee after jumping off a bunker on 15 July 2003.  During a physical therapy visit on 06 August 2003, 5 months before separation, the CI reported left knee pain since injury which was aggravated with flexion range of motion (ROM).  The examination showed an antalgic gait and pain with squatting.  The ROM was full with painful motion.  At an orthopedic evaluation on 6 August 2003, the CI reported left knee pain with prolonged sitting and locking.  The examination noted full ROM of the knee with painful motion.  There was tenderness to palpation over the inner aspect of the knee.  Patellofemoral compression was positive (positive grind test).  Radiographic imaging (MRI) was negative without meniscal or ligamentous tear.  No surgery was performed.  At a follow-up orthopedic examination in September 2003, the CI’s knee pain was improving and he was advised to attempt to increase his activities, but the pain increased with running.  Despite anti-inflammatory medications, physical therapy, and rest the left knee condition could not be adequately rehabilitated to meet the physical requirements of his military specialty and he was referred for a MEB.  The MEB forwarded “left knee pain” for PEB adjudication.

According to the MEB NARSUM in October 2003, 3 months before separation, the CI reported left knee pain with intermittent locking, pain with stairs and running, and prolonged sitting (Theater’s sign).  His physical examination revealed slight tenderness and positive patellofemoral compression test.  There was no joint effusion.  He had full active range of motion (ROM).  Provocative tests (varus/valgus and Lachman’s) for instability were negative.  

There was no VA Compensation and Pension (C&P) examination performed.  The only VA Rating Decision dated 08 January 2004 utilized the service treatment to render its rating.  

The Board directed attention to its rating recommendation based on the above evidence.  The PEB rated the condition 0% analogously coded 5299-5003 (degenerative arthritis), citing application of the US Army Physical Disability Agency Policy/Guidance Memorandum #13 (Pain Policy).  The VA rated the condition 10% coded 5299-5260 (analogous to limitation of flexion) based on the MEB NARSUM 3 months before separation, citing continued painful function impairing motion with activity, slight tenderness, and positive patellofemoral compression test.

Board members agreed there was no limitation of flexion or extension that supported a minimum rating under the VASRD diagnostic codes for limitation of motion (5260 or 5261).  However, there was evidence of painful motion with functional loss supporting a 10% rating (based on §4.59, §4.40 and §4.45).  There was no evidence of subluxation or lateral instability to support a separate 10% rating under the 5257 code (knee, other impairment).  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).  After due deliberation, and in consideration of all the evidence and mindful of VASRD §4.3 (reasonable doubt), the Board recommends a disability rating of 10% for the left knee pain condition coded analogously 5299-5260 IAW §4.59, §4.40 and §4.45.

BOARD FINDINGS:  In the matter of the left knee pain condition, the Board unanimously recommends a disability rating of 10%, coded 5299-5260 IAW VASRD §4.71a.  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	RATING	
Left Knee Pain 	5299-5260	10%	
RATING	10%	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20150526, 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, AR20160018684  (PD201500341)

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