RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXX	CASE:  PD-2012-01935
BRANCH OF SERVICE:  Army	BOARD DATE:  20140626
Separation Date:  20030530

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty SPC/E-4 (14T10/Patriot Enhancement Operator and Maintainer) medically separated for chronic left knee pain.  The condition could not be adequately rehabilitated 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 chronic left knee pain condition was forwarded to the Physical Evaluation Board (PEB) IAW AR 40-501.  No other conditions were submitted by the MEB.  The Informal PEB adjudicated chronic left knee pain following partial lateral meniscus tear status post (s/p) diagnostic arthroscopy as unfitting, rated 0%.  The CI made no appeals and was medically separated.

CI CONTENTION:  “ I have seen my doctor at least 25 times for my service-connected disability.  None of my conditions seem to be getting better worst on most cases.”

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 chronic left knee pain condition is addressed below; 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 20030318 | VA -  Exam ~ 1.5 Mos Pre-Separation
Condition | Code | Rating | Condition | Code | Rating | Exam
Chronic Left Knee Pain… | 5099-5003 | 0% | Chondromalacia Patellae, s/p Meniscectomy, Left Knee | 5260-5014 | 10%* | 20030415
No Additional MEB/PEB Entries | Other x6 |
Combined:  0% | Combined:  40%
* As reflected in VA Rating Decision (VARD) dated 20130430.  Original VARD not in evidence.

ANALYSIS SUMMARY:  The Board acknowledges the impairment with which his service-connected condition continues to burden him but notes the Disability Evaluation System 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.

Chronic Left Knee Pain Condition.  There were two goniometric range-of-motion (ROM) evaluations in evidence, with documentation of additional ratable criteria, which the Board weighed in arriving at its rating recommendation, as summarized in the chart below.

Left Knee ROM(Degrees) | MEB 5.5 Mo. Pre-Sep | VA C&P  1.5 Mo. Pre-Sep
Flexion (140 Normal) | 130 | 140
Extension (0 Normal) | 0 | 0
Comment | “daily pain with activities”; Pos. tenderness to palpation (TTP); Neg. instability; Normal strength | Pos. tenderness to ballottement (compress patella, release quickly); No instability; Pos. crepitus; “daily pain with activities”
§4.71a Rating | 10% | 10%

The CI sustained a twisting injury to his left knee in February 2001 and had an immediate onset of left lateral knee pain and significant loss of motion.  He developed multiple episodes of left knee locking and popping associated with pain and intermittent effusions.  The CI underwent a diagnostic arthroscopy for a left knee lateral meniscus tear in April 2001.  Despite a course of physical therapy (PT) the left knee continued to demonstrate tenderness to palpation (TTP) laterally with constant pain that was occasionally sharp.  A left knee X-ray ordered in October 2001, because of recurrent, pain was normal.  In January 2002, a PT note documented exam findings of medial knee pain with very TTP over the left medial collateral ligament at the joint line and positive for tight hamstring muscles on straight leg raise to 60 degrees.  The orthopedist in June 2002 noted that the CI had chronic left knee pain which interfered with his duties and ROM was limited to 135 degrees flexion.  The CI was given a permanent L3 profile for left knee pain with additional restrictions of no running, jumping or climbing.  The MEB narrative summary (NARSUM) exam dated 16 December 2002, approximately 5.5 months prior to separation, documented that the CI failed all conservative treatments since the arthroscopy and continued to have left knee swelling at night, difficulty with ambulation, running, and performing deep knee bends and a limited ROM.  The CI reported that the continued left knee pain ranged from sharp to dull depending on his activity.  The MEB NARSUM physical exam findings are summarized in the chart above.  The commander’s statement dated 11 March 2003 noted that he CI was very limited in performing duties with in his MOS.  A repeat left knee X-ray in April 2003 was normal.  The VA Compensation and Pension exam approximately 1.5 half months prior to separation documented that the CI continued to have daily left knee pain approximately seven of ten, worse with running, walking and climbing stairs.

The Board directs attention to its rating recommendation based on the above evidence.  The PEB coded the chronic left knee pain condition as 5099 analogous to 5003 arthritis, degenerative (hypertrophic or osteoarthritis) and rated it 0% citing “There is no joint instability or loss of range-of-motion.”  The VA applied the analogous code of 5260-5014, osteomalacia (which refers to code 5003 for rating) and rated the knee at 10%.  There is ample evidence of pain with activities in the service treatment record.  All exams proximate to separation documented painful motion.  No exam documented limited ROM to a compensable degree absent application of §4.59 (painful motion).  VASRD §4.71 specifies for 5003 that “satisfactory evidence of painful motion” constitutes limitation of motion and specifies application of a 10% rating for each such major joint or group of minor joints affected by limitation of motion.”  The Board considered alternate codes such as 5259 (symptomatic removal of semilunar cartilage), however, no other rating code would achieve a rating higher than 10%.  After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the Board recommends a disability rating of 10% 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.  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 chronic left knee pain condition, the Board unanimously recommends a disability rating of 10%, coded 5099-5003 IAW VASRD §4.71a.  There were no other conditions within the Board’s scope of review for consideration.

RECOMMENDATION:  The Board recommends that the CI’s prior determination be modified as follows, effective as of the date of his prior medical separation:

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 20121128, 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, AR20140020828 (PD201201935)

1.  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 to modify the individual’s disability rating to 10%  without recharacterization of the individual’s separation.  This decision is final.  

2.  I direct that all the Department of the Army records of the individual concerned be corrected accordingly no later than 120 days from the date of this memorandum.   

3.  I request that a copy of the corrections and any related correspondence be provided to the individual concerned, counsel (if any), any Members of Congress who have shown interest, and to the Army Review Boards Agency with a copy of this memorandum without enclosures.

 BY ORDER OF THE SECRETARY OF THE ARMY:

Encl						     XXXXXXXXXXXXXXX
						     Deputy Assistant Secretary
						         (Army Review Boards)

CF: 
(  ) DoD PDBR
(  ) DVA

PD-2012-01935