RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD1302103
BRANCH OF SERVICE:  Army	BOARD DATE:  20140619
SEPARATION DATE:  20060303

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty SPC/E-4 (44B10/Welder) medically separated for a right knee condition.  The 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).  Patellar chondromalacia and plica syndrome, characterized as not meeting retention standards, were forwarded to the Physical Evaluation Board (PEB) IAW AR 40-50.  The Informal PEB adjudicated right knee pain with no specific injury as unfitting, rated 10%, under the VA Schedule for Rating Disabilities (VASRD).  The CI made no appeals and was medically separated.

CI CONTENTION:  “This condition has gotten worse and developed into a serious problem in day to day living.  Currently on pain meds and knee injections.”

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 applicant.  The ratings for conditions meeting the above criteria are addressed below.  In addition, the Secretary of Defense directed a comprehensive review of Service members with certain mental health conditions referred to a disability evaluation process between 11 September 2001 and 30 April 2012 that were changed or eliminated during that process.  The applicant was notified that he may meet the inclusion criteria of the Mental Health Review Terms of Reference.  The mental health condition was reviewed regarding diagnosis change, fitness determination and rating in accordance with VASRD §4.129 and §4.130.  Any conditions or contention not requested in this application, or otherwise outside the Board’s defined scope of review, may be eligible for future consideration by the Board for Correction of Military Records.

RATING COMPARISON:

Service IPEB – Dated 20060207 | VA* - (2 Mos. Post-Separation)
Condition | Code | Rating | Condition | Code | Rating | Exam
Right Knee Pain With No Specific Injury and Plica Syndrome | 5099-5003 | 10% | Right Knee Meniscal Repair, s/p Arthroscopic Repair | 5299-5201 | 10% | 20060515
No MH Condition | Not Adjudicated | No VA Entry | 20060515
Other x 0 (Not in Scope) | Other x 8 | 20060515
Combined:  10% | Combined:  40%
* Derived from VA Rating Decision (VARD) dated 20070620 (most proximate to date of separation (DOS))

ANALYSIS SUMMARY:  IAW DoDI 6040.44, the Board’s authority is limited to making recommendations on correcting disability determinations.  The Board’s role is thus confined to the review of medical records and all evidence at hand to assess the fairness of PEB rating determinations, compared to VASRD standards, based on ratable severity at the time of separation.

Right Knee and Plica Syndrome Condition.  The narrative summary (NARSUM) recorded the CI underwent surgery of his right knee in September 2005 with medial plica resection, after a year and a half history of right knee pain.  VA treatment entry dated 24 July 2006, noted the CI reported he injured his right knee in an accident during physical training (PT) and had treatment and rehabilitation.  The CI reported pain intensity of 7 out of 10 (0-10 pain scale).  The examination dated 23 May 2006 documented normal right knee radiographs.  On physical examination, gait was normal and all joints and bones appeared normal on inspection and palpation.  There was no evidence of swelling or inflammation.  Range-of-motion (ROM), muscle strength, bulk and tone were all normal.  The physical profile indicated the CI could engage in unlimited walking, biking and swimming, and could run at his own pace and distance.  He was not able to move with a fighting load, perform squats or ruck sack.

At the MEB/NARSUM on 13 January 2006, approximately 2 months prior to separation, the CI noted he continued to have pain under the knee, which at times interfered with his ability to perform his job.  The physician noted the CI had not sustained a specific injury to the right knee.  Squatting, running, prolonged knee flexion and other activities increased the pain.  He reported occasional swelling and sleep difficulty.  The CI did not report any locking, giving way or instability.  The pain intensity on that day was about a 6 on a scale of 0-10.  Physical examination of the right knee showed a mild effusion with significant tenderness to palpation on the undersurface of the patella.  ROM recorded flexion of 115 degrees of the right knee and 130 of the left.  The examiner noted pain on motion during extreme flexion of the right knee; however, there was no evidence of inflammation, knee instability or obvious deformity.  His gait was slightly antalgic, opined to be secondary to pain.  The NARSUM noted radiographs of the right knee revealed no fractures, dislocations, and no inflammatory pathology (date not recorded).  Magnetic resonance imaging of the right knee, showed patellar retinacular degeneration (date not recorded).  The diagnoses of patellar chondromalacia and plica syndrome were recorded.

At the VA Compensation and Pension exam on 15 May 2006, approximately 2 months after separation, the CI reported both right ankle and knee pain.  He noted he injured his knee and ankle in august 2004 during physical training.  The CI rated his right knee pain at 6 out of a scale of 0-10 that was continuous and associated with weakness, stiffness, swelling and instability.  Precipitating factors included standing or prolonged walking, while ice with knee elevation improved his pain.  He was not using an assistive device.  He walked with a slight limp.  Physical examination, noted a height of 69.5 inches and weight of 258 pounded.  The surgical sites around his right knee were well healed; mild swelling was noted.  Crepitus was absent.  Flexion ROM recorded 135 degrees on the left.  Right knee ROM of 100 noted increase in pain on flexion; however, there was no decrease in ROM with repetitive testing.  There was no evidence of knee instability or neuromuscular compromise.

The Board directs attention to its rating recommendation based on the above evidence.  The PEB rated right knee pain condition (patellar chondromalacia) at 10% analogously to degenerative arthritis code of 5099- 5003, citing “slight loss of range of motion (115 degrees).”  The VA rated the condition at 10% citing painful motion, coded analogous 5299-5260.  A higher rating under the 5003 code requires compensable limitation of motion, evidence of painful motion or knee instability.  On review of the records, the Board noted the ROM was not compensable under 5260, 5261, 5257 or 5258.  All ROMs recorded were decreased; however, not to a compensable level.  There was no objective evidence of knee locking and effusions to support the use of code 5258.  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.
Contended PEB Conditions.  The Board noted the condition of “insomnia/depressive” recorded on the physical examination section of the MEB without reference to genesis and treatment.  The CI commented he at times became depressed because of his physical condition and his profile interfered with his ability to be promoted.  He had problems with sleep associated with pain in back, neck, shoulder, and knee.  The Board reviewed the available treatment records and found no evidence of treatment for any MH condition prior to separation.  There was no indication from the record that any MH condition significantly interfered with satisfactory duty performance.  No MH condition was profiled or implicated in the commander’s statement.  There was no evidence that the CI was ever diagnosed with an MH condition by any MH professional or received treatment from a MH professional.  The CI did not appear to meet the inclusion criteria of the Terms of Reference of the Mental Health Review project.  All Board members agreed the listing of the conditions on the MEB DD Form 2808 reflected reported symptoms and not an MH diagnosis.  The record sufficiently demonstrated the CI did not seek MH care at any time prior to separation.  After due deliberation in consideration of the preponderance of the evidence, the Board concluded that there was insufficient evidence that any MH condition rose to the level of being unfitting at the time of separation and therefore none were subject to service 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.  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 unanimously recommends no change in the PEB adjudication.  In the matter of the contended MH condition, the Board unanimously agrees that it cannot recommend it for disability rating.  There were no other conditions within the Board’s scope of review for consideration.

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

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20131024, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans’ Affairs Treatment Record

		
XXXXXXXXXXXXXXXXXX
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 XXXXXXXXXXXXXXXXXX, AR20140018689 (PD201302103)

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 of the Army
						          (Review Boards)
						         
CF: 
(  ) DoD PDBR
(  ) DVA

PD1302103