RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  	CASE:  PD1201131
BRANCH OF SERVICE:  Army	BOARD DATE:  20130509
SEPARATION DATE:  20030801

SUMMARY OF CASE:  Data extracted from the available evidence of record reflect that this covered individual (CI) was an active duty PFC/E-3 (11C/Indirect Fire Infantryman) medically separated for chronic right knee pain.  The right knee pain began in May 2002 without any specific injury or trauma.  He underwent non-surgical therapies without significant improvement in his symptoms, and in January 2003 had a diagnostic arthroscopy with a synovial debridement.  He then again was treated conservatively but the right knee could not be adequately rehabilitated to meet the physical requirements of his Military Occupational Specialty (MOS) or to 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 “chronic right knee pain (patellar tendonitis),” was forwarded to the Physical Evaluation Board (PEB) IAW AR 40-501.  No other conditions were submitted by the MEB.  The PEB adjudicated “chronic right knee pain without any history of trauma/injury” as unfitting, rated 0% citing criteria of the Veterans Affairs Schedule for Rating Disabilities (VASRD).  The CI made no appeals, and was medically separated.

CI CONTENTION:  “My right knee hasn’t improved at all, in fact it has gotten worse over the years since the injury.  It always feel like it going to blow out at anytime.  This condition I have is a result of my flat feet that doctors done nothing about when I was road marching in basic training.”

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.  The rating for the unfitting right knee condition is addressed below; and, no additional conditions are within the DoDI 6040.44 defined purview of the Board.  The requested flat foot condition was not identified by the MEB/PEB, and thus is not within the DoDI 6040.44 defined purview of the Board.  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 Board for Correction of Military Records.

RATING COMPARISON:  
   
Service IPEB (Dated 20030613)	VA (~1 month post-separation)  	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Right Knee Pain	5099-5003	0%	Right Patellar Tendonitis	5259	10%*	20030731	
No Additional MEB/PEB Entries	Other x 4	20030731	
Rating:  0%	Rating:  10%	
*Derived from VA Rating Decision (VARD) dated 20030828 (most proximate to date of separation [DOS]); revised to code 5024 in VARD dated 20050503 with same 10% rating.    

ANALYSIS SUMMARY:  The Board acknowledges the CI’s information regarding the significant impairment with which his service-connected condition continues to burden him; but, must emphasize that the Disability Evaluation System has neither the role nor the authority to compensate members for anticipated future severity or potential complications of conditions resulting in medical separation.  That role and authority is granted by Congress to the Department of Veterans Affairs, operating under a different set of laws (Title 38, United States Code).

Right Knee Condition.  The CI first began having right knee pain during basic training in May of 2002, without any specific trauma, or associated mechanical symptoms.  He was initially treated with physical therapy, activity modification, and medications, without success.  Given failed conservative therapy, the CI underwent a diagnostic arthroscopy in January 2003, with release of a synovial plica (abnormal band of tissue often a cause of knee pain).  There were no significant anatomic findings noted during the arthroscopy.  The CI’s pain worsened post-operatively, and again did not respond to multi-modality treatment.  He also began to complain of night-time discomfort, and was unable to run, walk substantial distances, or perform other MOS required tasks.  The CI’s right knee condition was consequently referred to the MEB.  The findings of the MEB narrative summary (NARSUM) examination dated 30 April 2003, approximately 3 months prior to separation, are shown in the range-of-motion (ROM) table below.  Knee radiographs performed in September 2002 were unremarkable.  Two magnetic resonance imaging (MRI) studies of the right knee, in October 2002 and in May 2003, were also essentially unremarkable, except for evidence of slight degenerative changes in the posterior horn of the medial meniscus, and thickening of the lateral aspect of the patellar tendon on the later MRI, consistent with patellar tendonitis or post-operative inflammation.  The NARSUM established a diagnosis of patellar tendonitis, associated with chronic “over-use”.  At the VA Compensation and Pension (C&P) exam performed a day prior to separation, the CI reported ongoing right knee pain.  Examination findings are noted in the ROM table below.  In short, there was no evidence of any abnormal findings except tenderness around the patella, both at rest and during knee extension.  Another VA examination was reviewed by the Board, dated   23 October 2003, approximately 2 months after date of separation.  The CI continued to complain of right knee pain with occasional “flares,” weakness and instability.  Again, there were no mechanical findings on evaluation, and the ROM, given in the table below, remained normal.  The goniometric ROM determinations in evidence which the Board weighed in arriving at its rating recommendation, with documentation of additional ratable criteria, are summarized as follows:

Right Knee ROM
(Degrees)	MEB/Ortho 
~ 3 Mo. Pre-Sep
(20030430)	VA C&P 
~ 1 day Pre-Sep
(20030731)	
VA C&P 
~  2½ Mo. Post-Sep
(20031023)	
Flexion (140 Normal)	155	140	140	
Extension (0 Normal)	0	0	0	
Comment	Tenderness
Pain with McMurray’s maneuver
No instability	Tenderness
Negative McMurray
No instability	Tenderness
Negative McMurray
No instability	
§4.71a Rating	0%	0%	0%	

The Board directs attention to its rating recommendation based on the above evidence.  The PEB rated the knee condition 0% under the analogous 5003 code (degenerative arthritis).  The PEB’s DA Form 199 reflected “chronic right knee pain” and “patellar tendonitis,” with “full ranges of motion without any ligamentous laxity;” the PEB applied rating criteria for single joint involvement with non-compensable ROM to arrive at its 0% rating under the 5003 code.  The VA rated the knee condition 10% under code 5259, removal of semilunar cartilage, symptomatic.  There was no limitation of motion or ligamentous instability for rating under the respective codes (5260, 5261, 5257).  The CI did not have a meniscus removed during surgery and there was no dislocated meniscus for rating under the related diagnostic codes.  The Board discussed whether there was sufficient evidence to support a 10% rating under provisions for painful motion (§4.59) and functional loss (§4.40).  All members agreed the functional limitations supported a 10% rating.  The Board concluded that there was no route to a rating higher than 10% under any applicable code and no coexistent pathology which would merit additional rating for the knee pain condition under a separate code.  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 CI’s 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.  The Board did not surmise from the record or PEB ruling in this case that any prerogatives outside the VASRD were exercised.  In the matter of the right knee condition, the Board unanimously recommends a disability rating of 10%, coded 5099-5024 IAW VASRD §4.71a.  There were no other conditions within the Board’s scope of review for consideration.

RECOMMENDATION:  The Board recommends that the CI’s prior determination be modified as follows, effective as of the date of his prior medical separation:

UNFITTING CONDITION	VASRD CODE	RATING	
Right Knee Condition	5099-5024	10%	
RATING	10%	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20120605, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans’ Affairs Treatment Record

	Physical Disability Board of Review

SFMR-RB									

MEMORANDUM FOR Commander, US Army Physical Disability Agency 
(TAPD-ZB), 

SUBJECT:  Department of Defense Physical Disability Board of Review Recommendation 
for AR20130011449 (PD201201131)

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,   I accept the Board’s recommendation to modify the individual’s disability rating to 10% without recharacterization 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:

Encl						
						         (Army Review Boards)

CF: 
(  ) DoD PDBR
(  ) DVA