RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXXXX	CASE:  PD-2015-00621
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20090326

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E1, Trainee, medically separated for “right knee pain,” with a disability rating of 10%.  

CI CONTENTION:  The CI made no specific contention.  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 - 20090317	VARD – No VA Claim	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Right Knee Pain	5099-5003	10%	NA	NA	NA	NA	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  NA	

ANALYSIS SUMMARY:  

Right Knee Pain.  According to service treatment records (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s right knee condition began 3 years prior to his enlistment in 2005 while at a football camp.  He re-injured his right knee while preparing to run in early February 2009 during physical training.  He reported that his right knee locked in the flexed position and he had pain at the anterior medial joint line.  He was evaluated by orthopedics.  Imaging studies showed minimal effusion and exams showed normal range of motion (ROM).  On 1 December 2008 (4 months prior to separation) the CI underwent an arthroscopic medical meniscal repair.  The surgeon performed a scope excision of a recurrent bucket handle medial meniscus tear.  

The CI had minimal pain postoperatively but the decision, in consultation with the CI and his parent was made to initiate the MEB process rather than to attempt to have him re-enter his military training.  The MEB forwarded “mild degenerative joint disease of right knee, status post medial meniscectomy after re-injury following meniscus repair” for PEB adjudication.  

At the NARSUM examination dated 12 February 2009, 2 months after surgery and 1 month prior to separation, the CI reported 2/10 right knee pain at the anteromedial joint line.  Examination showed the CI was in no acute distress and walked, sat, and stood with the right knee flexed.  The legs appeared strong, straight and equal, with no redness, swelling, heat, effusion, or tenderness to palpation.  The legs were neurovascularly intact.  Right knee ROM was 134/140/139 degrees (normal 140), and -6 degrees (normal 0) with no instability.  The CI did not submit a VA disability claim.  

The Board directed attention to its rating recommendation based on the above evidence.  The PEB rated the right knee condition 10%, coded analogously 5099-5003 (degenerative arthritis), citing pain limited motion.  There was no VA rating in evidence.  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 limitation of motion which attained a minimum rating under the diagnostic codes for limitation of flexion or extension (5260, 5261).  The examinations proximate to separation did not demonstrate the presence of ligamentous instability or laxity (5257).  There was a history of dislocated meniscus or loose body causing frequent locking with recurrent effusions (5258), (Cartilage, semilunar, dislocated, prior to surgical correction in December 2008, but there was no evidence of post-surgical frequent episodes of “locking,” pain, and effusion into the joint) which would warrant consideration of a 20% rating.  Alternative coding analogous to 5259 (Cartilage, semilunar, removal of, symptomatic) was considered due to excision of the bucket handle tear of the meniscus, but 5259 coding includes painful motion and would not rate higher than the 10% awarded by the PEB.  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 pain” condition.  

BOARD FINDINGS:  In the matter of the “right knee pain” 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.  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 20150603, with 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 XXXXXXXXXXXXXXXXXXXXX, AR20170000306 (PD201500621)

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