RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2015-00758
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20091221

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 “tenosynovitis, chronic right knee pain,” with a disability rating of 10%.

CI CONTENTION:  The CI’s request pertained to current attempts at re-enlisting.  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 on 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 - 20091110	VARD - 20101130	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Tenosynovitis, Chronic Right Knee Pain	5024	10%	Osgood-Schlatter's Disease, Right Knee	5299-5262	10%	20100831	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  10%	

ANALYSIS SUMMARY  

Tenosynovitis, Chronic Right Knee Pain.  According to service treatment records and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s right knee condition began in July 2002, prior to his accession to active duty in May 2008.  After accession to active duty, his right knee pain recurred in July 2008 associated with training but without specific trauma.  Radiographic studies were normal showing no arthritis or structural abnormalities.  There was no surgical indication, and conservative treatment did not result in improvement sufficient to allow unrestricted duty.  The MEB forwarded “chronic right knee pain with internal derangement” for PEB adjudication.  

At the time of the physical therapy clinic appointment on 6 August 2009, 5 months prior to separation, the examiner recorded that the CI had a slightly antalgic gait.   On examination right knee range of motion (ROM) was flexion 135 degrees (normal 140) and extension 0 degrees (normal 0) with pain occurring at 90 degrees of flexion.  A Lachman’s test was positive (Lachman 1, not clinically significant).  There was no swelling, atrophy, deformity or scarring.  During the MEB examination (recorded on DD Forms 2807 and 2808) dated 13 August 2009, 4 months prior to separation, the CI reported his knee swells, locks and gives way.  Physical examination showed antalgic gait due to knee pain, and tenderness to palpation (TTP) over right patellar tendon.   The MEB NARSUM, 6 October 2009, 3 months prior to separation, noted antalgic gait and TTP.  

At the 31 August 2010 VA Compensation and Pension (C&P) evaluation, performed 8 months after separation, the CI reported pain was aggravated by being on his feet more than an hour and walking more than 1/4 mile.   There were no complaints of locking or instability. The knee pain did not interfere with his usual occupation or activities of daily living. There was no swelling, redness, or tenderness.  On examination the gait was normal.  The right knee ROM was flexion 140 degrees (normal 140) and extension 0 degrees (normal 0).  A Lachman’s test was normal; there was no ligament laxity, and the medial and lateral ligaments were normal. There was no additional loss of range of motion, pain, fatigability, weakness, lack of endurance, or loss of coordination with three repetitions of movement.  

The Board directed attention to its rating recommendation based on the above evidence.  The PEB rated the right knee condition 10%, coded 5024 (tenosynovitis), citing evidence of pain with consideration given to 4.10 (functional impairment) and 4.40 (functional loss).  The VA rated the right knee condition 10%, coded 5299-5262 (impairment of tibia and fibula), citing malunion of the tibia and fibula with slight knee disability.  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 painful motion with functional loss supporting a 10% rating (based on §4.59, §4.40 and §4.45) as adjudicated by the PEB. 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) 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).  There was no VASRD §4.71a route to a rating higher than the 10% adjudicated by the PEB under any applicable code, and no grounds for additional rating based on the presence of instability.  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 condition.  

BOARD FINDINGS:  In the matter of the tenosynovitis, right knee condition and IAW VASRD §4.71a, the Board 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, 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 XXXXXXXXXXXXXXXXXX, AR20170000082 (PD201500758)

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