RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2015-01447
BRANCH OF SERVICE:  Army	SEPARATION DATE:  20070426

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E5, Recovery Vehicle Operator, medically separated for “right knee pain degenerative arthritis,” with a disability rating of 0%.

CI CONTENTION:  In spite of the medications, his shoulder and knees continue to become swollen and painful.  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 - 20070320	VARD - 20091208	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Right Knee Degenerative Arthritis	5003	0%	Right Knee Osteoarthritis	5010-5260	10%	20091005	
COMBINED RATING:  0%	COMBINED RATING OF ALL VA CONDITIONS:  20%	

ANALYSIS SUMMARY:

Right Knee Degenerative Arthritis.  According to service treatment records and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s right knee condition began in June 2003 after falling on the right side of his body.  He was treated conservatively with non-steroidal anti-inflammatory drugs (NSAIDs) and stretching exercises.  While in his second rotation of deployment, he complained of constant pain and walked with a limp and again was treated with NSAIDs and stretching and had physical therapy without improvement.  A magnetic resonance imaging (MRI) study performed in June 2006 demonstrated a small joint effusion, and mild degenerative changes with evidence of chondromalacia patella.  The CI’s anterior knee pain was considered to be bursitis and patellofemoral syndrome; however, orthopedic evaluation considered osteoarthritis of the right knee as the diagnosis and noted no surgical options were available.  However, an injection of a steroid mixture into the right knee was given on 27 November 2006.  Conservative treatment did not result in improvement sufficient to allow unrestricted duty and he was referred to an MEB.  The MEB forwarded “right knee pain secondary to degenerative changes” for PEB adjudication.

At an orthopedic visit in November 2006, 5 months before separation, the CI denied locking or instability and an MRI showed a small joint effusion, mild degenerative changes with signs of chondromalacia patella, and no other abnormalities.  At the MEB examination (recorded on DD Forms 2807 and 2808) in December 2006, the CI complained of swollen joints and knee trouble during deployment and prolonged pain when standing.  The examination revealed positive crepitus and an effusion of the right knee.  During the MEB NARSUM in March 2007, 2 months before separation, the examination revealed full range of motion (ROM) flexion and extension with slight pain.

At the VA Compensation and Pension (C&P) examination in October 2009, 29 months after separation, the CI reported having injured his right knee while deployed.  Since then, he experienced intermittent pain, which had progressively worsened.  He reported stiffness, swelling and pain with a severity level of 7/10 (10 being the worst pain).  The examination revealed tenderness and joint function limited by pain.  There were no signs of edema, instability, effusion, weakness, abnormal movement, guarding or subluxation.  Additionally, there was no locking pain or crepitus.  An X-ray series of the right knee demonstrated early osteoarthritis.

The ROM examinations 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)	PT ~13 Mos. Pre-Sep	MEB ~2 Mos. Pre-Sep	VA C&P ~29 Mos. Post-Sep	
Flexion (140 Normal)	110	“Full flexion”	140	
Extension (0 Normal)	0	“Full extension”	0	
Comment	Painful motion/crepitus/ patellar grind/valgus stress	“Full range of motion”
“Slight pain”	Tenderness/Painful motion	
§4.71a Rating	10%	10%	10%	

The Board directed attention to its rating recommendation based on the above evidence.  The PEB assigned a 0% rating coded 5003 (degenerative arthritis), citing full ROM and no instability.  The VA assigned a 10% rating analogously coded 5010-5260 (arthritis due to trauma to leg, limitation of flexion) based on the VA C&P examination 29 months after separation, citing full ROM with pain at 140 degrees of flexion.  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 those 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, the Board determined there was sufficient evidence of painful motion with functional loss to support a 10% rating (based on §4.59, §4.40 and §4.45).  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 right knee degenerative arthritis condition, coded 5099-5003.

BOARD FINDINGS:  In the matter of the right knee degenerative arthritis condition, the Board unanimously 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 Degenerative Arthritis	5099-5003	10%	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20150619, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

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 AR20160014800 (PD201501447)

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