RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2013-01688
BRANCH OF SERVICE:  Army	BOARD DATE:  20141218
SEPARATION DATE:  20040915

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E-4 (Unit Supply Specialist) medically separated for a right knee condition.  The condition could not be adequately rehabilitated to meet the physical requirements of her Military Occupational Specialty.  She was issued a permanent L3 profile and referred for a Medical Evaluation Board (MEB).  The right knee condition, characterized as “chronic right knee pain with right knee bone contusion,” was the only condition forwarded to the Physical Evaluation Board (PEB) IAW AR 40-501.  The Informal PEB adjudicated “chronic pain, right knee” as unfitting, rated 0% citing the US Army Physical Disability Agency (USAPDA) pain policy.  The CI made no appeals and was medically separated.

CI CONTENTION:  The CI elaborated no specific contention in her 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 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/Naval 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 confined to 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 IPEB – Dated 20040524	VA - (1 Mo. Post-Separation)  	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Pain, Right Knee	5099-5003	0%	Right Knee Condition	5299-5257	10%	20041018	
Other x 0 (Not in Scope)	Other x1	20041018	
Combined: 0%	Combined:  20%	
Derived from VA Rating Decision (VARD) dated 20110202 (only VARD in records but it reflects the ratings at time of date of separation [DOS]).

ANALYSIS SUMMARY:

Right Knee Condition.  The narrative summary stated that the CI began having bilateral knee pain in 2000 during Advanced Individual Training and was consistently diagnosed as patellofemoral syndrome (PFS).  Two years prior to separation, a right knee brace was prescribed.  Seventeen months prior to separation, imaging (magnetic resonance imaging) of the right knee showed a small joint effusion and a bony contusion (bruising) of the femur adjacent to the knee.  During the MEB exam, 5 months prior to separation, the CI reported she had had right knee swelling and tenderness approximately 25% of the day.  The examiner stated “Pain Rating:  Minimal and intermittent.”

The MEB physical exam noted a stable knee exam with crepitus, patellar grinding, mild effusion, pain with flexion and lateral patellar pain with pressure.  Goniometric measurements revealed pain-limited active right knee flexion of 0-125 degrees (normal 0-140 degrees).  There was no mention of repetition, use of a brace or abnormality of gait.  X-rays were abnormal (“physical scar not completely fused medial tibial plateau”).

At the VA Compensation and Pension exam performed a month after separation, the CI reported not using ambulatory or mechanical aids for ambulation.  She stated that she was not using her right knee brace because of poor fit.  The CI stated pain and swelling of both knees, more so on the right.  She complained of right knee pain about twice a week on average and denied instability, giving way, or fatigability.  On exam, the gait was normal.  There was minimal swelling of the right knee without effusion, spasm or laxity.  There was tenderness to palpation and “evidence of infrapatellar and patellar tendinitis.”  The knee had normal range-of-motion (ROM) bilaterally from 0-140 degrees.  There was no evidence of inflammatory arthritis at any joints.

The Board directed attention to its rating recommendation based on the above evidence.  The PEB rated the right knee at 0% citing the pain policy and coded analogously to 5003 (arthritis).  The VA rated the right knee at 10% for chondromalacia and PFS analogously to code 5257 (Knee, other impairment of-instability).  The right knee had painful knee motion in the records and exams which would warrant a 10% rating IAW VASRD §4.59 (painful motion).  The VA exam noted knee pathology IAW VASRD §4.45 (the joints) with mild (10%) knee impairment.  There was no instability, or compensable ROM-limitation for higher rating under knee-specific codes.  Although analogous codes of 5014 (Osteomalacia), 5024 (Tenosynovitis), 5010 (arthritis due to trauma), or 5257 were considered, none would offer any benefit over coding analogously to 5010-5003 at 10%.  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.

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.  As discussed above, PEB reliance on the USAPDA pain policy for rating the right knee condition was operant in this case and the condition was adjudicated independently of that policy by the Board.  In the matter of the right knee condition, the Board recommends a disability rating of 10%, coded 5010-5003 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 her prior medical separation:

UNFITTING CONDITION	VASRD CODE	RATING	
Chronic Pain, Right Knee	5010-5003	10%	
COMBINED	10%	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20130917, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans’ Affairs Treatment Record

XXXXXXXXXXXXXXXXXX
President
DoD 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 XXXXXXXXXXXXXXXXXX, AR20150008347 (PD201301688)

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						     XXXXXXXXXXXXXXXXXX
						     Deputy Assistant Secretary of the Army
						         (Review Boards)

CF: 
(  ) DoD PDBR
(  ) DVA