RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXX	CASE:  PD-2014-01177
BRANCH OF SERVICE:  Army	BOARD DATE:  20141107
SEPARATION DATE:  20090327

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty SGT/E-5 (42A20/Human Resources Specialist) medically separated for chronic right knee pain.  The right knee condition could not be adequately rehabilitated to meet the physical requirements of his Military Occupational Specialty.  He was issued a permanent L3 profile and referred for a Medical Evaluation Board (MEB).  The right knee condition, characterized as “chronic right knee pain without degenerative joint changes” was forwarded to the Physical Evaluation Board (PEB) IAW AR 40-501.  The MEB also identified and forwarded one other condition (chronic intermittent right shoulder pain) for PEB adjudication.  The Informal PEB adjudicated “chronic right knee pain without degenerative joint changes” as unfitting, rated at 10%, referencing the Veterans Affairs Schedule for Rating Disabilities (VASRD).  The remaining condition was determined to be not unfitting.  The CI made no appeals 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 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.  The not unfitting right shoulder condition was not contended and, thus is not within the DoDI 6040.44 defined purview of the Board.  This, and any condition 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.

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.

RATING COMPARISON:

Service IPEB – Dated 20081231	VA* - (3 Days Pre- Separation)	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Right Knee Pain	5099-5003	10%	Chronic Right Knee Bursitis	5019	10%	20090324	
Other x 1  (Not in Scope)	Other x 2	
Rating:  10%	Combined:  10%	
*Derived from VA Rating Decision (VARD) dated 20090813 (most proximate to date of separation)

ANALYSIS SUMMARY:

Right Knee Condition.  In 2002, the CI initially reported “pain and swelling” occurring in his right knee during physical training and later having episodes of pain and swelling while running.  Initial diagnosis was [right] knee bursitis and “runners” knee.  A 2004 magnetic resonance imaging (MRI) study of the knee revealed only a small joint effusion (collection of fluid) and possible “thinning of the medial malleolus”.  A follow-up MRI in 2006 was normal.  During his orthopedic evaluation dated 18 August 2008, the CI reported having right knee pain when running a mile or greater.  On physical exam, the examiner noted that the right knee was stable, without edema (swelling) and full range-of-motion (ROM).  A MRI obtained on 17 October 2008, revealed only “mild” evidence of patellar tendinitis.  Routine knee X-rays images were normal.

At the MEB NARSUM evaluation dated 15 December 2008 (3 months prior to separation), the CI reported that his knee periodically “give out” and having to wear a brace while running.  The examiner noted that the CI’s gait was normal, right knee ROM had a flexion of 102 degrees, extension of 0 degrees (normal 140 degrees and 0 degrees, respectively) without edema (swelling), muscle spasm or atrophy and normal motor strength.  The examiner referenced [right] knee X-ray image that revealed slight effusion and arthritis of the patella; actual report was omitted from available service treatment records for Board’s review.  The IPEB proceedings dated 31 December 2008, quoted an examination of the [right] knee, with a flexion of 102 degrees and without knee edema (swelling) or instability.

At the VA Compensation and Pension (C&P) examination dated 24 March 2009, the CI reported constant knee pain that’s exacerbated by standing or running.  On examination the CI’s gait and posture were normal; no edema (swelling) of the knee was present; flexion was 120 degrees, extension normal, there was pain and mild crepitus with “popping” of the right knee.  No instability was recorded.

The Board directs attention to its rating recommendation based on the above evidence.  The PEB and VA both rated the knee condition at 10% using different codes.  The PEB used codes 5099-5003 (analogous to arthritis) and the VA utilized code 5019 (bursitis).  No higher rating than 10% is achievable under either code.  The Board unanimously agreed that the knee condition rose to the level of 10%, but no more, for painful motion IAW §4.59.  The Board agreed the record in evidence did not support a rating under codes 5260, (limitation of flexion), or 5261, (limitation of extension) and that no rating higher than 10% was supported under code 5262, (knee impairment) as the Board unanimously agreed the knee condition did not rise to the threshold of “moderate severity”.  The Board agreed that no rating could be recommended under code 5258 (cartilage dislocated) as the record recorded no “frequent episodes, of locking or effusion of the knee”.  The Board then considered a rating under code 5257, (knee instability).  The Board noted the report by the CI of “the knee giving way” and “popping” in the NARSUM evaluation.  The Board agreed that these report were subjective as there were no clinical findings of knee instability on this or other proximate examinations.  The Board unanimously agreed it could recommend no rating under this code.  The Board found no other appropriate codes for rating consideration or pathway to a rating higher than 10% for the knee condition.  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 knee condition and IAW VASRD §4.71a, the Board unanimously recommends no change in the PEB adjudication.  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 20140122, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans’ Affairs Treatment Record

		
XXXXXXXXXXXXXXX
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 XXXXXXXXXXXXXXX, AR20150006610 (PD201401177)

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			     XXXXXXXXXXXXXXX
			     Deputy Assistant Secretary of the Army
			          (Review Boards)
						         
CF: 
(  ) DoD PDBR
(  ) DVA