RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2015-01781
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20071017

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

CI CONTENTION:  “Review all conditions.”  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 - 20070814	VARD 	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Right Knee Pain	5099-5003	0%	No VA examination in evidence	
Patellofemoral Syndrome, Right Knee	Not Unfitting		
Adjustment Disorder with Anxiety	Not Unfitting 		
Refractive Error, Myopia	Not Unfitting		
COMBINED RATING:  0%	COMBINED RATING OF ALL VA CONDITIONS:  N/A	

ANALYSIS SUMMARY:  

Chronic 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 in March 2006 after a twisting and inversion injury.  Initial radiographic (X-ray) studies showed no focal abnormalities; however, August 2006 studies showed a tiny Baker’s cyst, joint effusion, laxity in the ACL, an old medial collateral ligament injury, medial femoral condyle injury, and an anterior horn injury.  In November 2006, the CI underwent a right knee arthroscopic debridement.  Operative findings included a partial tear of the anterior horn of the right lateral meniscus.  Post-surgery, the CI continued to have right knee pain requiring physical therapy and a profile.  X-ray studies in February 2007 revealed no meniscal tear, but mild subchondral edema.  In March 2007, X-ray studies showed a persistent small joint effusion with likely partial thickness cartilage loss.  Despite treatment, the right knee condition could not be adequately rehabilitated to meet the physical requirements of the CI’s military specialty and the CI was referred for an MEB.  The MEB forwarded “tear of anterior horn of lateral meniscus, right knee” for PEB adjudication.  

At the time of the orthopedic clinic appointment on 26 April 2007, the CI reported bilateral knee pain, right greater than the left.  The CI reported taking Mobic for pain without relief.  The examination showed swelling, positive patella compression, 2+ medial and lateral joint line tenderness, and positive Moore sign.  A diagnosis of patellofemoral syndrome was noted.  

The MEB NARSUM examination on 3 July 2007, 3 months prior to separation, noted complaints of swelling behind the knee cap.  The CI reported difficulty with prolonged standing, walking up and down stairs, and squatting.  The pain was described as a constant dull ache with pounding and sharp pain.  The pain was rated on a scale of 4-6/10 and relieved by icing.  The CI reported occasional instability and falls.  The physical examination showed normal strength in the right lower extremity with flexion and extension, positive anterior and posterior drawer (cruciate ligament test), and minimal guarding with pivot shift.  

At the MEB examination (recorded on DD Forms 2807 and 2808) on 14 July 2007, 3 months prior to separation, the CI reported knee pain, popping, and instability.  Physical examination showed a right knee effusion, crepitus (grinding) with motion, and tenderness on palpation.

There was no VA Compensation and Pension (C&P) evaluation in evidence, 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 0%, coded 5099-5003 (arthritis, degenerative), citing full range of motion without joint instability, chronic pain, profile restrictions and functional limitations.  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), or history of surgery to remove cartilage (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). There was a history of debridement of the meniscus, pain, and recurrent effusions; however, there was no history of frequent locking for a rating under 5258.  Board member agreed that there was evidence of painful motion with functional loss supporting a 10% rating (based on §4.59, §4.40 and §4.45).  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.  

Contended PEB Conditions.  The Board’s main charge is to assess the fairness of the PEB’s determination that adjustment disorder with anxiety and refractive error, myopia, contended conditions were not unfitting.  Neither condition was profiled, implicated in the commander’s statement or judged to fail retention standards.  There was no performance-based evidence from the record that the conditions significantly interfered with satisfactory duty performance at separation.  After due deliberation, the Board concluded that there was insufficient cause to recommend a change in the PEB fitness determination for these two contended conditions and so no additional disability ratings are recommended.  

Patellofemoral Syndrome, Right Knee.  The impairment from the patellofemoral syndrome is subsumed under the overall rating for the “chronic right knee pain.” (§4.14 avoidance of pyramiding; more than one rating based on the same impairment is prohibited).  After due deliberation, the Board concluded that there was insufficient cause to recommend a change in the PEB fitness determination for the contended patellofemoral syndrome condition and so no additional disability ratings are recommended.  

BOARD FINDINGS:  In the matter of the chronic right knee pain condition, the Board unanimously recommends a disability rating of 10%, coded 5099-5003 IAW VASRD §4.71a.  In the matter of the contended adjustment disorder with anxiety; refractive error, myopia; and patellofemoral syndrome, right knee conditions; the Board unanimously recommends no change from the PEB determination as not unfitting.  There were no other conditions within the Board’s scope of review for consideration.  The Board therefore 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	
Chronic Right Knee Pain	5099-5003	10%	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20150628, 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, AR20170001960 (PD201501781)

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