RECORD OF PROCEEDINGS PHYSICAL DISABILITY BOARD OF REVIEW NAME: XXXXXXXXXXXXXXXXXX BRANCH OF SERVICE: ARMY CASE NUMBER: PD1200963 SEPARATION DATE: 20030430 BOARD DATE: 20130215 SUMMARY OF CASE: Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty PFC/E-3 (11B/Infantryman), medically separated for chronic left knee pain due to patellofemoral stress syndrome (PFS) that could not be adequately rehabilitated for the CI to meet the physical requirements of his Military Occupational Specialty (MOS) or satisfy physical fitness standards. He was issued a permanent L3 profile and referred for a Medical Evaluation Board (MEB). The MEB forwarded chronic knee pain to the Physical Evaluation Board (PEB) as the sole condition for adjudication. The PEB adjudicated the chronic left knee pain condition as unfitting, rated 10%, with application of the US Army Physical Disability Agency (USAPDA) pain policy. The CI made no appeals and was medically separated with a 10% disability rating. CI CONTENTION: “10% left knee Patella Flamoral (sic) Syndrome. 10% Mental Health Bi-polar Depression. PTSD argumental.” SCOPE OF REVIEW: The Board wishes to clarify that the scope of its review as defined in DoDI 6040.44, Enclosure 3, paragraph 5.e. (2) is limited to those conditions which were determined by the PEB to be specifically unfitting for continued military service; or, when requested by the CI, those condition(s) “identified but not determined to be unfitting by the PEB.” The chronic left knee pain is the only condition within the Board’s 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 Army Board for Correction of Military Records. RATING COMPARISON: Service IPEB – Dated 20030314 VA (2 Mos. Post-Separation) – All Effective Date 20030501 Condition Code Rating Condition Code Rating Exam Chronic Left Knee Pain 5099-5003 10% Patellofemoral pain syndrome 5299-5260 10% STR .No Additional MEB/PEB Entries. Not Service-Connected x 15299-5260 STR Combined: 10% Combined: 10%* *The 20100428 VARD added depression (9434) at 10%, effective 20090324, increasing overall combined rating to 20%. ANALYSIS SUMMARY: Chronic Left Knee Pain Condition: The CI first developed left knee pain after jogging in his early teenage years. At age 17, accession was not recommended, but in 1998 he was cleared for accession after a second orthopedic examination. During his first period of active service, he was seen twice in August 1998 for left knee pain. He was next seen in February 2002, a little over 3 months after returning to active duty. He was thought to have patello-femoral pain syndrome (PFPS) and treated conservatively. Over the next year, he was managed with medications, duty modification and physical therapy without improvement adequate for full duty. X-rays on 22 August 2002 and 24 September 2002 were normal. Magnetic Resonance Imaging (MRI) of left knee on 17 October 2002 was normal other than a small knee effusion. At the MEB evaluation on 10 January 2003, the CI reported he used a knee brace. In the narrative summary (NARSUM), accomplished the same day, the examiner noted tenderness and crepitus with motion. There was no instability. A mildly antalgic gait was noted on the NARSUM, but recorded as normal on the DD Form 2807. Range-of-motion (ROM) of knees was noted as zero degrees of extension (normal) and 120 degrees of flexion bilaterally (122 right and 118 left) on the DD 2807. The NARSUM documented “full range of motion of 90 degrees in flexion of the left knee. Extension is to about 5 degrees.” Provocative tests for instability, meniscal irritation and chondromalacia were normal. Strength was normal. The VA rated the knee based on the service treatment records (STRs). At a VA clinical visit 4 months after separation, the CI reported that he was working as a security guard and also cleared brush. The action officer opined that this is not consistent with a significant gait abnormality. The examiner documented an absence of atrophy and that the sensory, motor and reflex examinations were normal, but made no comment on gait. The Board directs attention to its rating recommendation based on the above evidence. The PEB rated the chronic left knee pain 10%, coded 5099-5003, analogous to degenerative arthritis, with application of the USAPDA pain policy. The VA also rated the knee condition at 10%, but coded it 5299-5260, analogous to limitation in flexion. The Board considered the diagnostic codes available for the knee. None provided a route to a higher rating than the 10% adjudicated for the left knee by the PEB. 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 chronic left knee pain 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. As discussed above, PEB reliance on the USAPDA pain policy for rating chronic left knee pain was operant in this case and the condition was adjudicated independently of that policy by the Board. In the matter of the chronic left knee pain 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 Chronic Left Knee Pain 5099-5003 10% COMBINED 10% The following documentary evidence was considered: Exhibit A. DD Form 294, dated 20120622, w/atchs Exhibit B. Service Treatment Record Exhibit C. Department of Veterans’ Affairs Treatment Record xxxxxxxxxxxxxxxxxxxxx, DAF Acting Director Physical Disability Board of Review SFMR-RB MEMORANDUM FOR Commander, US Army Physical Disability Agency (TAPD-ZB / xxxxxxxxx), 2900 Crystal Drive, Suite 300, Arlington, VA 22202-3557 SUBJECT: Department of Defense Physical Disability Board of Review Recommendation for xxxxxxxxxxxxxxxxxxxxx, AR20130005537 (PD201200963) 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)