RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD1300272
BRANCH OF SERVICE:  Army	BOARD DATE:  20131024
SEPARATION DATE:  20090625

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty SGT/E-5 (68W20/Medic) medically separated for a right knee condition.  In December of 2005, the CI had a trailer fall on his right leg injuring his right knee.  The right knee condition could not be adequately rehabilitated to meet the physical requirements of his Military Occupational Specialty or satisfy physical fitness standards.  He was issued a permanent L3 profile and referred for a Medical Evaluation Board (MEB).  The MEB forwarded chronic right knee pain status post (s/p) right knee arthroscopy with microfracture of the right medial femoral condyle, and s/p right HemiCap to the Physical Evaluation Board (PEB).  The PEB adjudicated the condition as right knee pain rated from arthritis, due to trauma while in Iraq; soldier had undergone a right knee arthroscopic medial meniscal repair and microfracture of the medial femoral condyle, and a right knee HemiCap procedure, as unfitting, rated 10% with likely application of Veterans Affairs Schedule for Rating Disabilities (VASRD).  The CI made no appeals and was medically separated.

CI CONTENTION:  “Prothetic [sic] Implant.”

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.  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 20090416	VA - Based on Service Treatment Records (STR)	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Right Knee Pain Rated From Arthritis	5010	10%	Status Postoperative Medial Meniscus Tear with Medial Femoral Condyle and Avascular Necrosis, RT Knee	5262	20%	STR	
No Additional MEB/PEB Entries	 	STR	
Combined:  10%	Combined:  20%	
Derived from VA Rating Decision (VARD) dated 20090304 (most proximate to date of separation [DOS]).

ANALYSIS SUMMARY: 

Right Knee Pain Condition.  The CI had an injury in August 2005 when a 5-ton trailer landed onto his right knee and ankle.  He had arthroscopic surgery on 14 February 2006 and was medevac’d from Kuwait for physical therapy on 24 June 2006.  He was subsequently scheduled for surgery at Walter Reed.  The CI underwent a procedure on 27 May 2008 commonly referred to as a partial knee replacement.  On 9 September 2008, right knee X-rays revealed stable post-surgical changes of tunneling of the right medial tibial plateau and orthopedic hardware in the right medial femoral condyle.  On 5 January 2009, he was profiled with a permanent lower extremity level 3 profile for right knee pain, s/p prosthetic implant surgery.  This prevented the CI from moving with a fighting load for at least 2 miles and an rendered him unable to construct an individual fighting position or do 3-5 second rushes under direct and indirect fire, which prevented deployments.  The commander’s statement indicated the CI was physically challenged to accomplish duties requiring lifting or carrying of heavy loads, and unable to perform medical evacuation operations requiring any lifting.  Additionally, the commander indicated his medical condition negatively impacted advancement and continued service especially in a tactical environment, in combat or in an emergency environment.  The NARSUM noted the CI reported pain at rest of 2 out of 10 in intensity.  Dull, achy pain was localized primarily to the medial joint line of the right knee and daily swelling.  The pain increased to 6-7 out of 10 with activities such as standing for more than 30 minutes, walking on uneven ground, running, jumping or walking up stairs.  The pain was somewhat relieved with rest and ice.  Physical examination revealed normal muscle strength, normal reflexes, no swelling of the right knee, a 10 cm vertical incision on the right medial joint line and negative anterior and posterior drawer signs.  There were no VA Compensation and Pension examinations in the record.
The VA used the service treatment record in awarding its rating determination.  

The Board directs attention to its rating recommendation based on the above evidence.  The Board considered VASRD diagnostic code 5010 (arthritis, due to trauma, substantiated by X-ray findings: rate as arthritis, degenerative) used by the PEB for a 10% rating.  The Board could not find evidence of a compensable ROM defect under codes 5256 (knee, ankylosis of), 5261 (e.g., limitation of extension of) or 5262 (tibia and fibula, impairment of), for a higher rating using this code or alternate knee codes.  The Board considered code 5262 (tibia and fibula, impairment of) used by the VA for a 20% rating.  The Board could not find evidence in the record to describe the disability as marked impairment of the knee or ankle for a higher adjudication.  The Board considered code 5055 (knee replacement [prosthesis]) and found that the 100% temporary disability rating for 12 months did not benefit the CI because the surgery was performed 13 months prior to separation.  A lengthy discussion ensued with respect to applicability of code 5055 and a minimum rating in this case.  A majority of the Board believed that the CI’s condition at separation did not approximate criteria supporting a 30% rating for his right knee.  The Board considered previous cases regarding partial and full knee replacement ratings heard at the VA Board of Appeals, and agreed that code 5055 does not differentiate between a partial and full knee replacement.  However, the majority also believed that application of the minimum rating in this case required evidence to support residual rating(s) under codes 5256, 5261 and/or 5262; and, that such evidence was not apparent in this case and thus provided no avenue for a higher postoperative permanent rating recommendation.  As stated above, the single vote of dissent on the case noted that VASRD code 5055 did not differentiate between a partial or a total knee replacement, and assigns a minimal disability rating of 30%.  After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the Board concluded that there was insufficient cause to recommend a change in the PEB adjudication 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.  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 pain condition, and IAW VASRD §4.71a, the Board recommends no change in the PEB adjudication by a vote of 2:1.  The single voter for dissent (who recommended code 5055 at 30%) did not elect to submit a minority opinion.

RECOMMENDATION:  The Board, therefore, recommends that there be no recharacterization of the CI’s disability and separation determination, as follows:

UNFITTING CONDITION	VASRD CODE	RATING	
Right Knee Pain Condition	5010	10%	
COMBINED	10%	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20130508, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans’ Affairs Treatment Record

XXXXXXXXXXXXXXXXXX
President
Physical Disability Board of Review
SFMR-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, AR20140006428 (PD201300272)

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 and hereby deny the individual’s application.  
This decision is final.  The individual concerned, counsel (if any), and any Members of Congress who have shown interest in this application have been notified of this decision by mail.

 BY ORDER OF THE SECRETARY OF THE ARMY:

Encl						     XXXXXXXXXXXXXXXXXX
						     Deputy Assistant Secretary
						         (Army Review Boards)