RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXX	CASE:  PD-2013-01919
BRANCH OF SERVICE:  Army 	BOARD DATE:  20150630
SEPARATION DATE:  20050127

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an activated Reserve E-4 (Motor Transport Operator) medically separated for a left knee condition.  The left knee condition 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).  “Three compartment chondromalacia” was forwarded to the Physical Evaluation Board (PEB) IAW AR 40-501.  No other condition was submitted by the MEB.  The Informal PEB adjudicated “chronic left knee pain” as unfitting, rated 0%, with likely application of the Veterans Affairs Schedule for Rating Disabilities (VASRD).  The CI made no appeals and was medically separated.  

CI CONTENTION:  The CI elaborated no specific contention in his application.  His complete submission is at Exhibit A.

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 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:  

IPEB – Dated 20041227	VA* - Exam not Available	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Left Knee Pain	5099-5003	0%	Traumatic Arthritis of Left Knee	5010	10%	Unknown	
Other MEB/PEB Conditions x 0 (Not In Scope)	Other x 5 	
RATING:  0%	COMBINED RATING:  30%	
*Derived from VA Rating Decision (VARD) dated 20080905 (Original VARD not available).  

ANALYSIS SUMMARY:  The left knee operative report and the VA Compensation exam and VA rating decision proximal to separation were not available in evidence before the Board and could not be located after appropriate inquiries.  Further attempt at obtaining the relevant documentation would likely be futile and introduce additional delay in processing the case; and, it is was judged by the members that the missing evidence would not alter the Board’s recommendations.

Left Knee.  According to the narrative summary (NARSUM) the CI was medically evacuated from Iraq after injuring his left knee in July 2004.  Arthroscopy in September 2004 revealed chondromalacia (inflammation and softening of the cartilage).  The CI continued to experience knee pain that interfered with performance of his military duties and his civilian duties as a security guard.  X-rays were normal, although a magnetic resonance imaging (MRI) study reportedly showed a possible medial meniscal tear.  The NARSUM examination performed on 16 November 2004 demonstrated “full range-of-motion” but specific measurements were not provided.  There was palpable crepitus, but the exam was silent regarding tenderness or painful motion.  There was no ligament instability.  The commander’s evaluation letter on 18 November 2004 confirmed that the CI was incapable of performing his duties due to pin in the left knee.  The MEB exam on 6 December 2004 noted weakness, swelling and tenderness of the left knee.  There was no other evidence proximal to the time of separation in the available record.

The Board directed attention to its rating recommendation based on the above evidence.  The PEB assigned a 0% rating coded analogously to 5003 (degenerative arthritis), citing normal X-rays and no loss of motion.  The initial VA rating decision was not available, but later decisions documented that a rating of 10% was assigned effective the day after separation.  The Board noted that there was no evidence of compensable limitation of motion.  Although there was not clear evidence of painful motion (VASRD §4.59), its presence was reasonably conceded given the findings of knee crepitus, weakness and tenderness in the context of tri-compartmental degenerative changes.  It was therefore concluded that a 10% rating was supported.  There was no route to a higher rating under the 5259 code (cartilage, semilunar, removal of, symptomatic), and no support for rating under the alternate knee codes 5257 (knee, other impairment of) and 5258 (dislocated semilunar cartilage).  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 left 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 chronic left knee condition, the Board unanimously recommends a disability rating of 10%, coded 5099-5003 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 his prior medical separation:  

CONDITION	VASRD CODE	RATING	
Chronic Left Knee Pain	5099-5003	10%	
RATING	10%	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20131001, 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 XXXXXXXXXXXXXXXXX, AR20150012497 (PD201301919)

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