RECORD OF PROCEEDINGS PHYSICAL DISABILITY BOARD OF REVIEW NAME: XXXXXXXXXXXXXXXXXX CASE: PD1201678 BRANCH OF SERVICE: ARMY BOARD DATE: 20130313 SEPARATION DATE: 20020526 SUMMARY OF CASE: Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty SGT/E-5 (88M/Motor Transport Operator) medically separated for right knee pain. The CI was in a motorcycle accident in 1996 and injured his right knee. He underwent arthroscopic surgery in 2001. The CI could not be adequately rehabilitated to meet the physical requirements of his Military Occupational Specialty (MOS) or satisfy physical fitness standards. He was issued a permanent L3 profile and referred for a Medical Evaluation Board (MEB). The right knee condition, characterized as right knee chondromalacia patella, anterior knee pain syndrome, and nonunion of patellar fracture, was forwarded to the Physical Evaluation Board (PEB) as medically unacceptable IAW AR 40-501. One other condition (identified in the rating chart below) was addressed by the MEB, and forwarded as meeting retention standards. The PEB adjudicated the right knee condition as unfitting, rated 20%, referencing the US Army Physical Disability Agency (USAPDA) pain policy. The remaining condition was determined to be not unfitting. The CI made no appeals, and was medically separated with a 20% disability rating. CI CONTENTION: The CI elaborated no specific contention in his application. SCOPE OF REVIEW: The Board’s scope of review is defined in DoDI 6040.44, Enclosure 3, paragraph 5.e.(2). It is limited to those conditions determined by the PEB to be unfitting for continued military service and those conditions identified but not determined to be unfitting by the PEB when specifically requested by the CI. Ratings for unfitting conditions will be reviewed in all cases. The right knee chondromalacia patella condition meets the criteria prescribed in DoDI 6040.44 for Board purview; and is addressed below. Any conditions or contention not requested in this application, or otherwise outside the Board’s defined scope of review, remain eligible for future consideration by the Army Board for Correction of Military Records. Also IAW DoDI 6040.44, the Board’s authority is limited to making recommendations on correcting disability determinations. The Board’s role is thus confined to the review of medical records and all evidence at hand to assess the fairness of PEB rating determinations, compared to the Veterans’ Administration Schedule for Rating Disabilities (VASRD) standards, based on ratable severity at the time of separation. RATING COMPARISON: Service IPEB – Dated 20020307 VA - (<1 Mos. Post-Separation) Condition Code Rating Condition Code Rating Exam Rt Knee Chondro-Malacia Patella, with Anterior Knee Pain Syndrome, DJD 5099- 5003 20% Status Post Fracture with Surgery and Degenerative Joint Disease of Right Knee 5010-5262 20% 20020605 Suspected Nocturnal Reflux Not Unfitting No VA Entry for Suspected Nocturnal Reflux No Additional MEB/PEB Entries Not Service Connected x 7 20020605 Combined: 20% Combined: 20% VARD 20020725 Most proximate to Date of Separation. No other VARDs in evidence ANALYSIS SUMMARY: Right Knee Pain. In 1996, the CI injured his right knee in a motorcycle accident. During the months that followed, his right knee pain became progressively worse. Many different treatment options were tried for his knee pain including: exercises, nonsteroidal anti- inflammatory drugs (NSAIDs), physical therapy (PT), and surgery. However, in spite of treatment his knee pain persisted and an MEB was initiated. The MEB orthopedic exam was at Fort Carson on 30 January 2002. His right knee had full range-of-motion (ROM), and no ligamentous laxity. There was some swelling and tenderness to palpation (TTP) along the superolateral border of the right patella. Crepitus was noted, consistent with early chondromalacia of the right knee. Lachman’s and pivot shift test were both negative. He had good patellar mobility without evidence of patellar instability. The right lower extremity was neurovascularly intact. Right knee flexion was measured to be 143 degrees. Ten days after separation, he had a VA Compensation and Pension (C&P) exam. He reported pain in the right knee; with stiffness, swelling, and locking. Active flexion of the right knee was 120 degrees, with pain on extreme flexion. There was some TTP over the lateral right patella, but no swelling. The two ROM exams that were weighed by the Board in arriving at its rating recommendation are summarized below. Right Knee ROM MEB – 4 mos. Pre-Sep (20020131) C&P – 10 days Post-Sep (20020605) Flexion (140° is Normal) 143°l 120° Comment Painful motion not noted Pain on extreme flexion §4.71a Rating 0% 10%* *10% based on VASRD §4.40 (Functional loss), §4.45 (The joints), and §4.59 (Painful motion) The Board carefully reviewed all evidentiary information available, and directs attention to its rating recommendation based on the above evidence. The PEB and the VA chose different coding options for the right knee condition, but both assigned a rating of 20%. Using data in the treatment record, the right knee was essentially non-compensable based on VASRD §4.71a codes for loss of knee motion (5260 and 5261), because the ROM was satisfactory. However; IAW VASRD §4.40, §4.45, and §4.59, a compensable rating is warranted when there is evidence of functional limitation due to painful motion of a major joint. The Board therefore determined that a 10% rating was warranted. As noted above, the PEB assigned a 20% rating for the right knee, and the Board is not permitted to recommend a rating lower than that. The Board tried to find a path to a rating higher than 20%, using other codes which could be applied to the right knee condition. The other VASRD codes that were considered did not result in a rating higher than 20%, since the treatment record did not show evidence of a significantly disabling joint abnormality which would justify a rating higher than 20%. 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 chronic right knee condition. BOARD FINDINGS: IAW DoDI 6040.44, provisions of DoD or Military Department regulations or guidelines relied upon by the PEB will not be considered by the Board to the extent they were inconsistent with the VASRD in effect at the time of the adjudication. In the matter of the chronic right knee condition and IAW VASRD §4.40, §4.45, §4.59, and §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. RECOMMENDATION: The Board, therefore, recommends that there be no recharacterization of the CI’s disability and separation determination, as follows: UNFITTING CONDITION VASRD CODE RATING Chronic, Painful Right Knee Condition 5099-5003 20% RATING 20% The following documentary evidence was considered: Exhibit A. DD Form 294, dated 20120612, w/atchs Exhibit B. Service Treatment Record Exhibit C. Department of Veterans’ Affairs Treatment Record xxxxxxxxxxxxxxxxxxxxxxxxxx, DAF Acting Director Physical Disability Board of Review SFMR-RB MEMORANDUM FOR Commander, US Army Physical Disability Agency (TAPD-ZB / xxxxxxxxxxxxxx), 2900 Crystal Drive, Suite 300, Arlington, VA 22202-3557 SUBJECT: Department of Defense Physical Disability Board of Review Recommendation for xxxxxxxxxxxxxxxxxxxxxxxx, AR20130006858 (PD201201678) 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: Encl xxxxxxxxxxxxxxxxxxxxxx Deputy Assistant Secretary (Army Review Boards)