RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXX	CASE:  PD-2013-01564
BRANCH OF SERVICE:  Army	BOARD DATE:  20141113
SEPARATION DATE:  20040908

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty SGT/E-5 (31B/Military Police) medically separated for right knee pain.  The knee condition did not improve adequately to meet the physical requirements of his Military Occupational Specialty or satisfy physical fitness standards.  He was issued a permanent L3 profile and underwent a Medical Evaluation Board (MEB).  The right knee condition, characterized as “right knee pain secondary to chondromalacia of the patella” was forwarded to the Physical Evaluation Board (PEB) IAW AR 40-501.  No other conditions were submitted by the MEB.  The PEB adjudicated “right knee pain” as unfitting, rated at 0%.  The CI made no appeals and was medically separated.

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.  The rating for the unfitting right knee condition is addressed below.  No other conditions are within the defined purview of the Board.  Any conditions outside the Board’s scope of review may be eligible for consideration by the Board for Correction of Military Records.

RATING COMPARISON:

Service IPEB – dated 20040426	VA – (2 mos. Pre-Separation) 	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Right Knee Pain	5099-5003	0%	Right Knee Condition	5261-5010	10%	20040713	
Other x 0  (Not in Scope)	Other x 5 (Not in Scope)		
Combined:  0%	Combined:  10%	
Derived from VA Rating Decision (VARD) dated 20041105 (most proximate to date of separation)

ANALYSIS SUMMARY:

Right Knee Pain.  In August 2000, the CI injured his right knee during a platoon run.  Magnetic resonance imaging revealed a meniscal tear.  In February 2001, the CI had arthroscopic surgery on the right knee.  After surgery, he continued to have right knee pain.  Due to the chronic, persistent nature of his knee pain, an MEB was initiated.  The MEB narrative summary (NARSUM) was dictated on 9 February 2004.  At that exam, right knee range-of-motion (ROM) was 0 to 130 degrees with pain at extreme motion.  Tests for ligamentous laxity were negative.  There was pain with pressure on the anterior patella.  Apprehension test was negative, and normal patellar tracking was noted.  The examiner’s diagnosis was: right knee pain, due to chondromalacia of the patella.  A month later, on 9 March 2004, knee ROM was measured and recorded.  Those measurements are summarized in the chart below.

Two months prior to separation from service, the CI had a VA Compensation and Pension (C&P) exam, the examiner noted that the CI was walking with a limp, and using a cane.  He reported that he could walk a maximum of a half mile.  On physical examination (PE) of the right knee, there was mild crepitus.  Tests for ligamentous laxity were negative.  The CI was able to toe walk, heel walk, and tandem walk; although he would not do so initially.  The examiner opined that the CI may have desired to appear more disabled than he actually was.  For Functional Assessment, the examiner wrote: “The veteran reports to be significantly disabled, however, this cannot be verified accurately on today’s exam, as his symptoms subjectively offered, seem out of proportion to his x-ray and physical findings.”  The ROM evaluations, which the Board weighed in arriving at its rating recommendation, are summarized in the chart below.

Right Knee ROM
(Degrees)	MEB ~ 7 mos. Pre-Sep
(20040209)	PES ~ 6 mos. Pre-Sep
(20040309)	VA C&P ~ 2 mos. Pre-Sep
(20040713)	
Flexion (140 Normal)	130	110	99	
Extension (0 Normal)	0	-10	-25	
Comment	Pain with motion	Flexion contracture?	Flexion contracture?	

The Board carefully reviewed the ROM data from the knee examinations noted above.  At the 
March 2004 examination, the examining doctor mentions a flexion contracture of the right knee.  However, with passive ROM testing, the right knee can be extended to 0 degrees (full extension), proving that there is no flexion contracture.  Four months later, at the July 2004 VA’s C&P exam, right knee extension was listed as -25 degrees active and -20 degrees passive.  These measurements again raise the question of a flexion contracture.  However, the CI was able (with coaxing) to walk on his toes, walk on his heels, and tandem walk.  The Board determined that it would be virtually impossible to perform those maneuvers with a unilateral flexion contracture of 20 or 25 degrees.  Posture and gait at that exam were recorded as normal.  The Board determined that it would be virtually impossible to have normal posture and gait with a unilateral flexion contracture of 20 or 25 degrees.

Due to the inconsistencies noted in those two exams, the Board determined that the PE with greatest probative value was the MEB NARSUM exam from 9 February 2004.  That exam was very thorough and was performed by the Chief of Orthopedics.  At that exam, right knee ROM was 0 to 130 degrees with pain at extreme motion.  Using data from the February 2004 MEB NARSUM exam, the Board determined that the CI’s right knee condition was essentially non-compensable based on the Veterans Affairs Schedule for Rating Disabilities (VASRD) §4.71a diagnostic codes for loss of knee motion (5260 and 5261).  However, the CI does warrant a 10% rating under code 5299-5259 (analogous to cartilage, semilunar, removal of, symptomatic).  He had arthroscopic debridement of his right lateral meniscus, and after surgery continued to have knee pain.  The Board could find no path to a higher rating since there was insufficient evidence of a significantly disabling knee abnormality that would justify a higher rating.  After due deliberation, the Board determined that a disability rating of 10% was appropriate.  Considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the Board unanimously recommends a rating of 10% for Right knee pain, due to chondromalacia.  It is appropriately coded 5299-5259 and IAW VASRD §4.71a, meets criteria for the 10% rating.

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.  Army PEB reliance on the USAPDA pain policy may have been operant in this case and the condition was adjudicated independently of that policy by the Board.  In the matter of the right knee pain condition, the Board unanimously recommends a 10% disability rating, coded 5299-5259 IAW VASRD §4.71a.  There were no other conditions within the Board’s scope of review for consideration.

RECOMMENDATION:  The Board, therefore, 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	
Chronic Right Knee Pain, Secondary to Chondromalacia	5299-5259	10%	
RATING	10%	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20130920, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans’ Affairs Treatment Record

XXXXXXXXXXXXXXX
President
Physical Disability Board of Review

SAMR-RB									

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 XXXXXXXXXXXXXXX, AR20150006996 (PD201301564)

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			     XXXXXXXXXXXXXXX
			     Deputy Assistant Secretary of the Army
			         (Review Boards)

CF: 
(  ) DoD PDBR
(  ) DVA