RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXXXX	CASE:  PD-2015-00695
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20041110

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

CI CONTENTION:  The CI contends his condition should be changed because his condition continues to worsen and negatively impact quality of life.  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 - 20040924	VARD - 20050411	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Right Knee Pain…	5099-5003	0%	Patellofemoral Arthrosis and Patellar Tendonitis	5024	0%	20050104	
COMBINED RATING:  0%	COMBINED RATING OF ALL VA CONDITIONS:  10%	

ANALYSIS SUMMARY:  

Right Knee Pain Diagnosis.  According to service treatment records (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s right knee condition began in June 2003 when she twisted her right knee while running.  Right knee X-rays showed a lateral subluxation of the patella with magnetic resonance imaging showing mild degenerative changes or contusion of the medial meniscus and a small cyst behind the intact anterior cruciate ligament.  A primary care visit in October 2003 noted patellar subluxation.  An orthopedic evaluation on 26 November 2003 noted tenderness to palpation of the patella with lateral laxity.  At a follow up orthopedic visit patellar instability was noted and the CI was given a stability brace.  A later visit indicated there was some improvement noted with physical therapy and the knee was noted to be “stable” with residual pain with patellar compression.  The MEB forwarded “right knee patellofemoral arthrosis and patellar tendonitis” for PEB adjudication.  

At the MEB examination in July 2007, 3 months prior to separation, the CI reported locking out, giving out, continuous pain and loss of balance due to the knee.  Physical exam showed no swelling behind the knee or evidence of anterior-posterior or lateral instability.  The MEB NARSUM examination on 7 July 2004, 3 months prior to separation, noted complaints of impaired right leg balance, difficulty with steps, pain described as achy, with an ability to only walk 1/2 mile and sit less than 10 minutes.  Functional limitations included inability to lift greater than 30 pounds, run, march or ruck march.  Physical examination showed alignment of the lower extremities was neutral, with bilateral flat foot and in toeing of the right foot (abnormal, should be straight).  There was “no marked crepitus”, but there was pain with patellofemoral compression.  There was tenderness to palpation of the patellar tendon.  Knee range of motion (ROM) was as recorded in the chart below.  

At the 4 January 2005 VA Compensation and Pension (C&P) evaluation, performed 2 months after separation, the CI reported occasional swelling and pain when going up and down stairs or keeping the knee in a position too long (i.e. sitting or standing greater than 30 minutes).  Physical exam showed a normal gait.  There was no heat, swelling, or evidence of meniscal injury.  Testing for anterior-posterior and lateral instability of the knee joint was negative.  Knee ROM was as recorded in the chart below, with no complaints of pain.  There was no additional loss of ROM with repetition.  Right knee X-rays were interpreted as normal.

The ROM evaluations in evidence which the Board weighed in arriving at its rating recommendation, with documentation of additional ratable criteria, are summarized in the chart below. 

Right Knee ROM
(Degrees)	MEB ~4 Mos. Pre-Sep
(20040707) p.34	VA C&P ~2Mos. Post-Sep
(20050104) p. 176	
Flexion (140 Normal)	0-130	0-140	
Extension (0 Normal)	No Stated	0-Full Extension	
Comment	 pain with patella compression, tenderness to palpation in the patellar tendon, pain with extended activity 	No objective painful motion; gait within normal limits; no change with repetitive motion, no fatigue	
§4.71a Rating	10%	0%	

The Board directed attention to its rating recommendation based on the above evidence.  The PEB rated the right knee condition 0%, coded 5099-5003 (arthritis, degenerative), citing the US Army Physical Disability Agency (USAPDA) pain policy.  The VA rated the right knee condition 0% coded 5024 (tenosynovitis), based on the VA C&P examination 2 months after separation, citing normal knee with full range of motion.  There was no limitation of motion which supported a rating under the diagnostic codes for limitation of flexion or extension (5260, 5261).  However, there was evidence of degenerative changes on MRI with limited ROM noted at the MEB NARSUM examination for 10% rating under 5003 and related codes since the CI was given a diagnoses of patellar arthrosis and patellar tendonitis at separation.  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).  Board members considered if dual rating was warranted for the patellar instability noted in the STR, including by the orthopedic specialist.  However, there was no documentation of recurrent episodes of patellar subluxation.  The CI participated in physical therapy and following this the orthopedic specialist noted the knee was “stable” with residual pain with patellar compression.  The Board agreed that the evidence did not support sufficient functional impairment due to instability apart from pain to warrant dual rating of the knee in this case.  The knee could be alternatively be rated at 10% coded as 5257 for slight patellar instability causing the predominate symptom of pain and Board consensus was that a higher rating for moderate knee impairment due to instability was not supported given the normal gait and normal knee exam with no use of a brace mentioned at the C&P exam shortly after separation.  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 5099-5003.  

BOARD FINDINGS:  In the matter of the right knee condition, the Board unanimously or majority recommends a disability rating of 10%, coded 5099-5003 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	PERMANENT RATING	
Right Knee Pain	5099-5003	10%	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20150602, 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

SUBJECT:  Department of Defense Physical Disability Board of Review Recommendation for XXXXXXXXXXXXXXXXXXXXX, AR20170000053 (PD201500695)

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