RECORD OF PROCEEDINGS PHYSICAL DISABILITY BOARD OF REVIEW NAME: XXXXXXXXXXXXXXXXX BRANCH OF SERVICE: ARMY CASE NUMBER: PD1201413 SEPARATION DATE: 20020625 BOARD DATE: 20130305 SUMMARY OF CASE: Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty SGT/E-5 (55B/Ammunition Specialist), medically separated for right knee pain. The CIs experienced an acute onset of knee pain while running in December 1998. Despite treatment he did not improve and was not able 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 no other conditions for Physical Evaluation Board (PEB) adjudication. The PEB adjudicated the right knee condition as unfitting, rated 0%, which was increased to 10% after an Informal Reconsideration applied 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: “When I got out of the Army for a knee injury that rendered me from walking normal or running with pain. After about 3 or 4 years from leaving the Army I could not take the pain anymore and found a civilian doctor and from the x-rays and MRI that were done in February 2006, he determined that I needed to have surgery that could possibly repair my right knee to where I could do things almost normal again. To this day am still not able run normal, but can walk better but with some pain. About 2007 I went to the Veteran's Affairs Medical Center in Richmond, VA and the doctor said that it looked like there was build up of fluid around my right knee, but was never scheduled for an appointment to have it examined to verify if there was fluid build up or not.” 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 ratings for unfitting conditions will be reviewed in all cases. 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 Informal Recon – Dated 20020318 VA (No exam in evidence) – All Effective Date 20020626 Condition Code Rating Condition Code Rating Exam Right Knee Pain 5099-5003 10% Right Knee Crepitus 5299-5010 10% No Exam .No Additional MEB/PEB Entries. 0% X 0 / Not Service-Connected x 4 Combined: 10% Combined: 10% ANALYSIS SUMMARY: The Disability Evaluation System (DES) is responsible for maintaining a fit and vital fighting force. While the DES considers all of the member's medical conditions, compensation can only be offered for those medical conditions that cut short a member’s career, and then only to the degree of severity present at the time of final disposition. 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 nor for conditions determined to be service-connected by the Department of Veterans Affairs (DVA) but not determined to be unfitting by the PEB. However the DVA, operating under a different set of laws (Title 38, United States Code), is empowered to compensate all service-connected conditions and to periodically re-evaluate said conditions for the purpose of adjusting the Veteran’s disability rating should the degree of impairment vary over time. The Board’s role is 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 severity at the time of separation. Right Knee Condition. The CI had an acute onset episode of right knee pain in December 1998, after running, without any evidence of trauma. X-ray exam of the right knee performed in November 2000 was normal. He reinjured his right knee by twisting it on 12 March 2001, while throwing ammunition from a truck. Magnetic resonance imaging (MRI) exam from March 2001 noted small signal change within the posterior horn of the medial meniscus (possible posterior meniscal horn tear), intact cruciate and collateral ligaments as well as patellar and quadriceps tendons. No effusion or cartilage defect was observed. Contusion of the medial femoral condyle was mentioned in the report. Orthopedic evaluation did not recommend surgical treatment. The CI complained of persistent right knee pain accentuated by squatting and heavy lifting unalleviated by treatment. The MEB narrative summary (NARSUM) physical exam dictated 16 April 2001, 18 months prior to separation, noted normal gait, no effusion and no joint line tenderness. There was mild tenderness to palpation over the patellar tendon and very mild crepitus. Range-of-motion was 135 degrees flexion and zero degrees extension. McMurray test was negative for meniscus pathology, and there was no ligamentous instability. The examiner rated the anterior right knee pain slight and constant and considered the condition to be stable. No VA Compensation and Pension (C&P) examination was available for review. The Board directs attention to its rating recommendation based on the above evidence. The PEB rated the condition 10% with application of the USAPDA pain policy (coded 5099-5003). The VA adjudicated the same 10% disability rating using code 5299-5010. There was no limitation of motion or instability to warrant a minimum rating under the respective VASRD diagnostic codes (5260, 5261, and 5257). There was not a dislocated meniscus with locking to support a minimum rating under 5258 (dislocated meniscus). The Board noted the contusion of the medial femoral condyle mentioned in the magnetic resonance exam from 11 March 2001, however there was no malunion to assign a rating under the 5255 code (Impairment of the femur). The Board noted the pain with squatting and heavy lifting supported consideration for a minimum rating under §4.59 (painful motion) or §4.40 (functional impairment). The Board agreed there was no evidence to support a rating higher than the 10% adjudicated 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 right 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 the right knee condition was operant in this case and the condition was adjudicated independently of that policy by the Board. In the matter of the right 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 Right Anterior Knee Pain 5099-5003 10% RATING 10% The following documentary evidence was considered: Exhibit A. DD Form 294, dated 20120604, w/atchs Exhibit B. Service Treatment Record Exhibit C. Department of Veterans’ Affairs Treatment Record xxxxxxxxxxxxxxxxxxxxxxx DAF Acting Director Physical Disability Board of Review SFMR-RB MEMORANDUM FOR Commander, US Army Physical Disability Agency (TAPD-ZB / xxxxxxxx), 2900 Crystal Drive, Suite 300, Arlington, VA 22202-3557 SUBJECT: Department of Defense Physical Disability Board of Review Recommendation for xxxxxxxxxxxxxxxxxx, AR20130005365 (PD201201413) 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 xxxxxxxxxxxxxxxxxxxxxxxx Deputy Assistant Secretary (Army Review Boards)