RECORD OF PROCEEDINGS PHYSICAL DISABILITY BOARD OF REVIEW NAME: XXXXXXXXXXXXXXXXXX BRANCH OF SERVICE: ARMY CASE NUMBER: PD1201098 SEPARATION DATE: 20010921 BOARD DATE: 20130226 SUMMARY OF CASE: Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty PFC/E-3 (74B/Information Systems Analyst), medically separated for chronic pain, right knee, due to retropatellar pain syndrome. The CI reports injuring his right knee on an obstacle course during Basic Training. He continued experiencing pain toward the end of his Basic Training in the fall of 2001. Upon arrival to his Advanced Individual Training (AIT) at Fort Gordon, GA he passed the initial diagnostic physical fitness test but continued experiencing right knee pain. He was evaluated by Orthopedics and Mental Health for stress related to his knee pain and his inability to participate in the physical requirements of his training. The CI did not improve adequately and was unable to meet the physical requirements of his AIT and was referred by Orthopedics for a Medical Evaluation Board (MEB). The MEB forwarded no other conditions for Physical Evaluation Board (PEB) adjudication. The PEB adjudicated the right knee pain condition as unfitting, rated 0% with application of the US Army Physical Disability Agency (USAPDA) pain policy. The CI made no appeals, and was medically separated with a 0% disability rating. CI CONTENTION: “Right knee and left foot.” 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. The rated condition chronic pain, right knee, due to retropatellar pain syndrome, as requested for consideration, is the only condition that meets the criteria prescribed in DoDI 6040.44 for Board purview; and, is addressed below. 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 PEB – Dated 20010904 VA (14 Mos. Post-Separation) – All Effective Date 20020927 Condition Code Rating Condition Code Rating Exam Chronic Right Knee Pain Due to Retropatellar Pain Syndrome 5099-5003 0% Retropatellar Pain Syndrome, Right Knee 5014 10% 20021109 Combined: 0% Combined: 10%* *VARD dated 20111202 awards a combined rating of 50% effective 20091101 based upon increases in conditions not in the scope of this board. The scope condition remains at 10% through all VARDs. ANALYSIS SUMMARY: It is noted for the record that the Board recognizes the significant interval (14 months) between the date of separation and the VA evaluation. DoDI 6040.44, under which the Board operates, specifies a 12-month interval for special consideration to VA findings. This does not mean that the VA information was disregarded, as it was a valuable source for clinical information and opinions relevant to the Board’s evaluation. In matters germane to the severity and disability at the time of separation, however, the information in the service record was assigned proportionately more probative value as a basis for the Board’s rating recommendations. Chronic Right Knee Pain. There were two (2) 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. Right Knee ROM (Degrees) NARSUM ~3 Mo. Pre-Sep VA C&P ~14 Mo. Post-Sep Flexion (140 Normal) 130 140 Extension (0 Normal) “0 to -5”* 0 Comment +Crepitus, tenderness. No instability +Mild crepitus, “occasional locking,” no painful motion §4.71a Rating 0% or 10% (PEB 0%) 0% or 10% (VA 10%) *Minus 5 refers to hyperextension The narrative summary (NARSUM) dated 27 June 2001 referred to two separate physical exams in March and May 2001, respectively, which were not available for review. The NARSUM notes that the CI “states….he’s had continuous pain in his right knee.” The NARSUM author’s separate exam of the right knee noted no laxity, edema, or instability. Tests for potential anterior cruciate ligament (ACL) injury (anterior drawer, Lachman and pivot shift) and meniscus injury (McMurray) were negative. The examiner noted “an unimpressive patellar grind.” The gait was non-painful. Magnetic resonance imaging (MRI) of the right knee was unremarkable; there was no effusion or abnormalities of ligaments, tendons or joint surfaces. The report of the VA Compensation and Pension (C&P) exam in November 2002, 14 months after separation, noted pain, stiffness, “occasional locking,” fatigability, and lack of endurance involving the right knee. The right knee condition had a “minimal effect on his occupation or daily activities.” The examiner noted a normal gait and no apparent functional limitations on standing and walking. The report referred to an undated X-ray which reportedly showed no abnormalities of the bones or compartment spaces. The Board directs attention to its rating recommendation based on the above evidence. The PEB assigned a 0% rating under an analogous 5003 code (degenerative arthritis). The VA assigned a 10% rating under the 5014 code (osteomalacia). Board members agreed that a 10% rating is reasonably conceded with application of §4.40 (Functional loss) in view of the impact on his MOS duties, or IAW §4.59 (Painful motion) given physical examination findings. After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (Resolution of reasonable doubt), the Board recommends a disability rating of 10% 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 chronic right 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 right 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 Right Knee Due to Retropatellar Pain Syndrome 5099-5003 10% COMBINED 10% The following documentary evidence was considered: Exhibit A. DD Form 294, dated 20120621, w/atchs Exhibit B. Service Treatment Record Exhibit C. Department of Veterans’ Affairs Treatment Record xxxxxxxxxxxxxxxxxxxxxxxxxxx, DAF Acting Director Physical Disability Board of Review SFMR-RB MEMORANDUM FOR Commander, US Army Physical Disability Agency (TAPD-ZB / xxxxxxxxxxxxxx), 2900 Crystal Drive, Suite 300, Arlington, VA 22202-3557 SUBJECT: Department of Defense Physical Disability Board of Review Recommendation for xxxxxxxxxxxxxxxxxxxxxxxx, AR20130007795 (PD201201098) 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 xxxxxxxxxxxxxxxxxxxxxxxxx Deputy Assistant Secretary (Army Review Boards)