RECORD OF PROCEEDINGS PHYSICAL DISABILITY BOARD OF REVIEW NAME: XXXXXXXXXXXXXXXX CASE: PD1200682 BRANCH OF SERVICE: ARMY BOARD DATE: 20130424 SEPARATION DATE: 20011017 SUMMARY OF CASE: Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty PFC/E-3 (67U10/CH-47 Helicopter Repairman) medically separated for left knee condition. The CI attributed recurring left knee pain to running while in basic training, but noted an exacerbation from a direct blow to her knee against a wall while rappelling. The left knee condition could not be adequately rehabilitated to meet the physical requirements of her Military Occupational Specialty (MOS) or satisfy physical fitness standards. She was issued a permanent L3 profile and referred for a Medical Evaluation Board (MEB). The left knee condition, characterized as retropatellar pain syndrome, was forwarded to the Physical Evaluation Board (PEB) IAW AR 40-501. No other conditions were submitted by the MEB. The Informal PEB (IPEB) adjudicated left retropatellar pain syndrome as unfitting, rated 10% with application of the Veteran’s Affairs Schedule for Rating Disabilities (VASRD). The CI made no appeals, and was medically separated with a 10% combined disability rating. CI CONTENTION: “I continue to experience problems with my left knee (numbness, tingling, buckling, locking). I have been through physical therapy twice with no relief or improvements. I am also not a candidate for surgery. In addition, I have/am experiencing the same issues with my right knee. These issues affect my quality of life in that I cannot perform certain activities, such as running, at all or on a limited basis, such as walking long periods, playing with my daughter, squatting, etc.” 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 left 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 20010918 Based on Service Treatment Record (STR) Condition Code Rating Condition Code Rating Exam Left Retropatellar Pain 5299-5003 10% Retropatellar Pain Syndrome, Left Knee 5299-5261 10% STR No Additional MEB/PEB Entries Retropatellar Pain Syndrome, Right Knee 5299-5261 NSC STR Other x 1 STR Combined: 10% Combined: 10% Derived from VA Rating Decision (VARD) dated 20020225 [most proximate to date of separation (DOS)]. ANALYSIS SUMMARY: The Board acknowledges the sentiment expressed in the CI’s application regarding the significant impairment with which her service-incurred condition continues to burden her. The Board wishes to clarify that it is subject to the same laws for service disability entitlements as those under which the Disability Evaluation System (DES) operates. The DES has neither the role nor the authority to compensate members for anticipated future severity or potential complications of conditions resulting in medical separation. That role and authority is granted by Congress to the Department of Veterans Affairs, operating under a different set of laws (Title 38, United States Code). Left Retropatellar Pain Syndrome. An outpatient note (15 February 2001) reported a normal X- ray of the left knee. A magnetic resonance imaging (MRI) of the left knee (March 2001) showed normal alignment, a small effusion, and normal cartilage, ligaments, and menisci. Physical therapy notes during February,-April 2001, noted subjective pain rated at 8-9/10 (1-10 scale). At the narrative summary (NARSUM) exam, on 27 July 2001, the CI denied locking in flexion or giving way of the knee. The NARSUM was silent regarding functional status but stated, “…her condition has been severe to the point of…preventing her participation in PT.” The physical exam noted pain on patellar motion with mild retropatellar tenderness, positive grind, and no effusion. The ligament and meniscus tests were negative. Range-of-motion (ROM) evaluation noted flexion of 145 degrees (normal to 140 degrees) and extension of zero degrees (normal to zero degrees). X-rays reportedly showed a slight lateral tilt of the patella consistent with a lateral compression syndrome. The Board directs attention to its rating recommendation based on the above evidence. The PEB’s 10% rating was based on an analogous 5003 code (degenerative arthritis). The VA also assigned a 10% rating under an analogous 5261 code (leg, limitation of extension of). Board members agreed that there was no limitation of motion, but that a 10% rating was justified by sufficient evidence painful motion (§4.59). There was no evidence of instability to warrant additional rating under 5257 (Knee, other impairment of), and no evidence to justify a rating higher than 10% under other knee codes. 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 left retropatellar pain syndrome 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 left retropatellar pain syndrome 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, as follows: UNFITTING CONDITION VASRD CODE RATING Left Retropatellar Pain Syndrome 5299-5003 10% COMBINED 10% The following documentary evidence was considered: Exhibit A. DD Form 294, dated 20120608, w/atchs Exhibit B. Service Treatment Record Exhibit C. Department of Veterans’ Affairs Treatment Record xxxxxxxxxxxxxxxxxxxxxxxxx, DAF Director of Operations Physical Disability Board of Review SFMR-RB MEMORANDUM FOR Commander, US Army Physical Disability Agency (TAPD-ZB / xxxxxxxxxxxxxxxx), 2900 Crystal Drive, Suite 300, Arlington, VA 22202-3557 SUBJECT: Department of Defense Physical Disability Board of Review Recommendation for xxxxxxxxxxxxxxxxxxxxx, AR20130009552 (PD201200682) 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 xxxxxxxxxxxxxxxxxxxxxxx Deputy Assistant Secretary (Army Review Boards)