RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2015-01564
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20050318

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an activated National Guard E4, Light Wheel Vehicle Mechanic, medically separated for “degenerative joint disease right knee,” with a disability rating of 10%.

CI CONTENTION:  The CI contended that the rating for his right knee should be changed because he had a knee replacement.  He also contended that he should be rated for post-traumatic stress disorder (PTSD), hearing loss, and sleep apnea.  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 - 20050225	VARD - 20140122	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Degenerative Joint Disease Right Knee	5003	10%	Right Knee Degenerative Joint Disease	5003	NSC	20131230	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  NSC	

Analysis Summary:

Degenerative Joint Disease Right Knee.  According to service treatment records (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI underwent right knee surgery in July 2004 for anterior collateral ligament tear and chondromalacia.  Following surgery further treatment did not result in improvement sufficient to allow unrestricted duty.  The MEB forwarded “degenerative joint disease of the right knee” for PEB adjudication.  

At the time of the physical therapy clinic appointment on 3 August 2004, 1 month after surgery and 8 months prior to separation, the CI reported that his right knee locks up after prolonged sitting and that he has numbness in his leg.  On examination his range of motion (ROM) was decreased with flexion of 100 degrees (normal 140) and an extension of 5 degrees (normal 0).    The examination was silent in regards to painful motion.  The CI had decreased strength (4/5) to the muscles of the right leg.  At the time of the orthopedic clinic appointment on 9 August 2004, 1 month after surgery and 7 months prior to separation, the CI reported minimal knee pain and improved ROM, but still complained of paresthesias in the right leg.  On examination his ROM was decreased with a flexion of 105 degrees and an extension of 5 degrees.  The examination was silent in regards to painful motion.  His gait was slightly antalgic and he had decreased sensation to his right leg.  The examiner noted slight effusion.  At the time of the physical therapy clinic appointment on 31 August 2004, 2 months after surgery and 7 months prior to separation, the CI reported that he had met maximum benefit and saw no improvement.  On examination his ROM was decreased with a flexion of 100 degrees and an extension of 5 degrees.  The examination was silent in regards to painful motion.  He had full strength (5/5) in both legs, but there was decreased sensation down the right leg.  

The MEB NARSUM, 28 December 2004, 3 months prior to separation, noted 7 out of 10 right knee pain with walking more than 100 feet.  It also noted that the CI was unable to stand for more than 10 minutes and had paresthesia in his right lower leg.  

There was no VA Compensation and Pension (C&P) examination within 12 months of separation in evidence.  The CI did not request a VA disability claim until 6 February 2013, 8 years after separation.

The Board directed attention to its rating recommendation based on the above evidence.  The PEB rated the right knee condition 10%, coded 5003 (degenerative arthritis), citing radiographic evidence with minimal limitation of motion.  The VA denied service connection for the right knee degenerative joint disease, citing the condition neither occurred in nor was caused by service.  Although there was no compensable limitation of motion under the diagnostic codes for limitation of flexion or extension (5260, 5261), a 10% rating was warranted under diagnostic code 5003 for a major joint with objectively confirmed degenerative arthritis affected by limitation of motion that was otherwise non compensable.  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 the respective codes.  There was no fracture, non-union, or mal union of the femur or tibia to support consideration under the respective codes for knee impairment related to long bone conditions (5255, 5262).  There was therefore 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 degenerative joint disease right knee condition.

BOARD FINDINGS:  In the matter of the degenerative joint disease of the right knee 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, w/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

20 MAR 2017

SUBJECT:  Department of Defense Physical Disability Board of Review Recommendation for 
XXXXXXXXXXXXXXXXXX, AR20170001295 (PD201501564)

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