Author: JOHN J. D'ORAZIO
Last saved by: WEATHERS, JANICE R SrA USAF AFRBA AFRBA/AFBCMR
Company: Pre-installed Company

RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	 	CASE:  PD1300278	
BRANCH OF SERVICE:  ARMY		BOARD DATE:  20130821
released from active duty:  20030106
separated from reserve status:  20050425

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was a Reservist, SGT/E-5 (92A20/Automated Logistical Specialist) medically separated for chronic right knee pain after injury while on a period of mobilization, status post (s/p) arthroscopic debridement of meniscal injuries, with additional findings of chronic chondromalacia of the knee joint which was determined to have existed prior to service (EPTS).  During a period of activation, the CI twisted his right knee in January 2002.  An arthroscopy and debridement while he was forward deployed in May 2002 disclosed abnormalities.  After redeployment he was seen by orthopedic surgery in December 2002, but cleared for demobilization.  His unit reactivated in January 2003; however he had persistent knee pain and did not activate.  He was released from active duty and returned to his civilian job as a heavy equipment operator.  His regional surgeon issued a P4 profile in September 2003 and referred the CI to the Medical Evaluation Board (MEB) for a fitness for duty determination.  In April 2004, he had a second arthroscopy at the VA hospital.  Due to persistent pain, the CI’s condition could not be adequately rehabilitated to meet the physical requirements of his Military Occupational Specialty (MOS) or satisfy physical fitness standards.  The chronic right knee pain/right knee arthritis was the only condition forwarded by the MEB to the Physical Evaluation Board (PEB) IAW AR 40-501 in December 2004.  The PEB adjudicated the right knee condition as unfitting, rated 0%.  The CI made no appeals and was medically separated.

CI CONTENTION:  “I had to have my knee replace in 2010”

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 additional conditions are within the Board’s defined DoDI 6040.44 purview.  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 20050321 | VA **
Condition | Code | Rating | Condition | Code | Rating | Exam
Chronic Right Knee Pain* | 5099-5003 | 0% | Degenerative Joint Disease, Rt Knee | 5010 | 10% | 20040213
No Additional MEB/PEB Entries | Other x 2 | 20040213
Combined:  0% | Combined:  10%
Derived from VA Rating Decision (VARD) dated 20030309.
* Chronic related chondromalacia of the right knee was deemed to be EPTS.
** VA Exam was ~ 13 mos after Release From Active Duty; ~ 14 mos before final Date of Separation from reserve status

ANALYSIS SUMMARY:

Chronic Right Knee Pain Condition.  The service treatment record notes that the CI sustained a right knee injury in January 2002 with subsequent chronic right knee pain and swelling.  In May 2002, he underwent a partial right medial meniscectomy.  Medial femoral condyle chondromalacia was documented during this surgery.  Postoperatively, the CI continued to report right knee pain and swelling.  Several treatment records notes document findings of right knee tenderness to palpation (TTP), decreased active range-of-motion (ROM) and persistent joint effusions.  In April 2004, at the VA medical center, the CI underwent a second right knee partial medial meniscectomy.  The narrative summary (NARSUM) dictated 8 months prior to final separation from reserve status (4 months post second arthroscopy) notes decreased, but persistent pain in the right knee s/p two arthroscopic partial medial meniscectomy surgeries.  The NARSUM examination was significant for full, active and painful ROM; TTP along the medial joint line, a negative McMurray and trace effusion.  There was 5/5 muscle strength without quad or calf atrophy.  At the VA Compensation and Pension exam performed 13 months after release from active duty and 14 months prior to final separation from reserve status, the CI reported intermittent swelling, locking and grinding of the right knee joint.  The CI also reported stiffness, weakness and 5 out of 10 daily pain.  The symptoms are aggravated by walking and climbing in and out of heavy equipment.  The physical evaluation demonstrated right knee swelling, TTP along the medial joint line, crepitus and difficulty standing from a squatting position.  Stability maneuvers and ROM were normal.  The examiner also noted that the left shoe exhibited more wear than the right.

The Board directs attention to its rating recommendation based on the above evidence.  The PEB adjudicated the right knee condition as chronic right knee pain analogous to degenerative arthritis with a disability rating of 0%.  The VA coded the right knee condition as arthritis due to trauma with a disability rating of 10%.  The Board considered that at the time of separation the treatment records documented objective findings of EPTS arthritic changes and a service-related injury resulting in two arthroscopic meniscal surgeries.  The Board determined that both conditions were contributory to the persistent right knee pain.  The right knee condition was implicated in the commander’s statement and adversely impacted the CI’s ability to perform the duties of his MOS.  The Board determined that Veterans Affairs Schedule for Rating Disabilities (VASRD) criteria for code 5010 (arthritis due to trauma) most closely approximated the clinical evidence of chronic knee pain.  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.  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 right knee pain condition, the Board unanimously recommends a disability rating of 10%, coded 5010 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:

UNFITTING CONDITION | VASRD CODE | RATING
Chronic right knee pain | 5010 | 10%
COMBINED | 10%
The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20130506, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans’ Affairs Treatment Record

XXXXXXXXXXXXXXXXXXX, DAF
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 XXXXXXXXXXXXXXXXXXXXXXXXX, AR20140000663 (PD201300278)

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						     XXXXXXXXXXXXXXXXXXXXXX
						     Deputy Assistant Secretary
						         (Army Review Boards)

PD1300278