RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  xxxxxxxxxxxxxxxxxxxx	CASE:  PD-2013-01710
BRANCH OF SERVICE:  Army	BOARD DATE:  20150416
SEPARATION DATE:  20040721

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was a Reserve (temporary tour of active duty) O-2 (Field Artillery) medically separated for a right knee condition.  The knee condition could not be adequately rehabilitated to meet the physical requirements of his specialty or satisfy physical fitness standards.  He was issued a permanent L3 profile and referred for a Medical Evaluation Board (MEB).  The MEB forwarded “degenerative joint disease” to the Physical Evaluation Board (PEB) IAW AR 40-501.  No other condition was submitted by the MEB.  The Informal PEB adjudicated “degenerative arthritis of the right knee” as unfitting, rated 0%.  The CI submitted a rebuttal.  The US Army Physical Disability Agency reviewed the rebuttal, affirmed the PEB findings, and issued an Administrative Correction to the original PEB proceedings.  The CI made no further appeals at that time 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 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:

Admin Correction IPEB – Dated 20040220	VA* – based on Service Treatment Record (STR)	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Degenerative Arthritis of Right Knee	5003	0%	Degenerative Joint Disease of Right Knee	5260-5003	10%	STR	
Other x 0 (Not In Scope)	Other x 7 	
RATING:  0%	RATING:  10%	
*Derived from VA Rating Decision (VARD) dated 20050325 (most proximate to date of separation (DOS))

ANALYSIS SUMMARY:

Right knee condition.  This CI has had a long history of right knee pain.  He had arthroscopic surgery on the right knee in 1988, 1990, and 1991.  In May 2003, he aggravated his right knee pain while running.  A short time later, he deployed overseas with his unit.  While deployed, his right knee continued to give him problems.  In July 2003, the CI was medically evacuated from theater and returned to the US.  Magnetic resonance imaging showed degenerative joint disease (DJD), but no evidence of acute meniscal or ligamentous injury.  Due to the chronic, persistent nature of his right knee pain, MEB was initiated.  The full MEB physical examination (PE) was in October 2003.  But, a detailed exam of the right knee was performed by orthopedics in July 2003.  At that July 2003 exam, there was medial joint line tenderness, and trace effusion present.  The knee was stable to anterior, posterior, varus, and valgus stress.  Lachman’s test was negative, and McMurray’s sign was equivocal.  Range-of-motion (ROM) was 10 degrees to 110 degrees.  The MEB narrative summary (NARSUM) was prepared on 12 November 2003.  In the NARSUM, the examiner’s diagnosis was: Right knee medial compartment DJD, with past history of arthroscopic repair (times 3) for torn meniscus.

The CI was medically separated from service on 21 July 2004.  A month after separation, on 19 August 2004, he was examined at a VA Medical Center.  He did not complain of joint pain at that time, and his gait was normal.  On PE, there was no swelling or erythema (redness) of his joints.  On 2 September 2004, the CI was seen by orthopedics.  The PE of the right knee showed some tenderness and crepitus.  Tests for ligamentous laxity were negative.  Right knee ROM was 0 degrees to 120 degrees, with pain.  

The ROM evaluations in evidence which the Board weighed in arriving at its rating recommendation are summarized in the chart below.

Right Knee ROM
(Degrees)	
PT ~ 12 mos. Pre-Sep
(20030724)	NARSUM ~ 8 mos. Pre-Sep
(20031112)	Ortho ~ 6 weeks Post-Sep
(20040902)	
Flexion (140 Normal)	95	60	120	
Extension (0 Normal)	5	10	0	

The Board directed attention to its rating recommendation based on the above evidence.  The Board determined that the September 2004 orthopedic exam was just 6 weeks after the DOS, and therefore carried significant probative value.  At that exam, right knee ROM was 0-120 degrees, with pain.  The knee condition was essentially noncompensable, based solely upon the VASRD §4.71a codes for loss of knee motion.  However, a 10% rating is warranted under diagnostic code 5259 (Cartilage, semilunar, removal of, symptomatic).  There was no path to a higher rating for the right knee since there was insufficient evidence of ligamentous instability, subluxation, or other seriously disabling joint abnormality that would justify a higher rating.  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 unfitting right knee condition.  It is appropriately coded 5259, and IAW VASRD §4.71a, meets criteria for a 10% disability 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.  In the matter of the right knee condition, the Board unanimously recommends a disability rating of 10%, coded 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:

CONDITION	VASRD CODE	RATING	
Degenerative arthritis of the right knee 	5259	10%	
COMBINED	10%	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20131008, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

XXXXXXXXXXXXXXXXXXXX
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 xxxxxxxxxxxxxxxxxxxxxxxx, AR20150012517 (PD201301710)

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