RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2013-01530
BRANCH OF SERVICE:  Army	BOARD DATE:  20150123
SEPARATION DATE:  20040114

SUMMARY OF CASE: Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E-4 (Petroleum Supply Specialist) medically separated for left knee pain.  The condition could not be adequately rehabilitated to meet the requirements of her Military Occupational Specialty; however, her profile indicated she could perform an alternate PT test (walk instead of run), so she was issued a permanent L3 profile and referred for a Medical Evaluation Board (MEB).  The knee condition, characterized as “left knee pain,” was forwarded to the Physical Evaluation Board (PEB) IAW AR 40-501.  The MEB also identified and forwarded four other conditions (bilateral foot pain, hip pain, hearing loss and back pain) for PEB adjudication.  The Informal PEB adjudicated the left knee pain as unfitting, rated 0%, with likely application of the VA Schedule for Rating Disabilities (VASRD).  The remaining conditions were determined to be not unfitting.  The CI made no appeals and was medically separated.

CI CONTENTION:  The CI elaborated no specific contention in her application.

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 when specifically requested by the CI, those conditions identified by the PEB, but determined to be not unfitting.  Any conditions outside the Board’s defined scope of review and any contention not requested in this application may remain eligible for future consideration by the Board for Correction of Military Records.  Furthermore, the Board’s authority is limited to assessing the fairness and accuracy of PEB rating determinations and recommending corrections, where appropriate.  The Board’s assessment of the PEB rating determinations is confined to review of medical records and all available evidence for application of the Veterans Affairs Schedule for Rating Disabilities (VASRD) standards to the unfitting medical condition at the time of separation.  The Board has neither the role nor the authority to compensate for post-separation progression or complications of service-connected conditions.  That role and authority is granted by Congress to the Department of Veterans Affairs, operating under a different set of laws.  The Board gives consideration to VA evidence, particularly within 12 months of separation, but only to the extent that it reasonably reflects the severity of the disability at the time of separation. 

RATING COMPARISON:

Service IPEB – Dated 20031027	VA - (6 Mos. Post-Separation)  	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Left Knee Pain…	5003	0%	Retropatellar Pain Syndrome with Arthritis, Left Knee	5257	10%	20040427	
Other x 4 (Not in Scope)	Other x 13	20040427	
Rating:  0%	Combined:  50%	
Derived from VA Rating Decision (VARD) dated 20040726.

ANALYSIS SUMMARY:

Left Knee Condition.  The narrative summary noteed the CI developed left knee pain without trauma in April 2001.  She was diagnosed with bursitis and given a steroid injection with temporary improvement.  The CI had persistent pain and was diagnosed with retropatellar pain syndrome.  Left knee X-rays performed on 30 July 2002 showed mild degenerative changes.  Conservative treatment did not resolve the knee pain and orthopedic evaluation on 12 August 2002 noted knee range-of-motion (ROM) of extension limited by 5 degrees and flexion of 130 degrees, there was tenderness of the inside of the knee, but no effusion and no evidence of instability or cartilage injury.  Magnetic resonance imaging of the left knee noted some tiny cysts of the knee near the lateral meniscus without an associated tear and no other abnormality was noted.  Despite additional physical therapy the CI continued to report knee pain.  At the MEB examination on 16 June 2003, 5 months prior to separation, the CI reported left knee pain aggravated by activity.  The MEB physical examination noted tenderness to palpation over the anterior knee, no evidence of semilunar cartilage injury, instability, or laxity.  ROM was extension–flexion of 0 degrees to 135 degrees (normal 0 degrees to 140 degrees).  Sensation and reflexes were normal.  Special testing by the orthopedic specialist on 13 September 2002 noted tenderness of the inside of the patella, with no medial or lateral joint line tenderness, no instability, and a negative patellar grind test.

At the VA Compensation and Pension examination on 27 April 2004, performed 6 months after separation, the CI reported constant left knee pain which did not incapacitate her and she had not lost any time from work.  The VA exam noted a normal gait.  Examination of the left lower leg was normal and ROM was extension–flexion of 0 degrees to 110 degrees.  There was a knee effusion, without instability or evidence of cartilage injury.  No additional imaging was performed because the CI was pregnant at the time of the examination.

The Board directed attention to its rating recommendation based on the above evidence.  The PEB rated the left knee condition 0%, coded 5003 (degenerative arthritis) and the VA rated it 10%, coded 5257 (knee impairment).  The Board agreed that the evidence in record supports a 10% rating IAW §4.71a with multiple codes-5003, 5260 (limited leg flexion), or 5261 (limited leg extension) IAW §4.59 (Painful motion), but does not achieve a 20% rating for two more joints with evidence of degenerative arthritis, or based on limitation of ROM alone.  The Board also considered if there was evidence of instability to provide for dual rating based on separate ratings for instability and limitation of motion.  However, there was no evidence in record of knee instability, laxity or intermittent patellar dislocation.  The Board agreed there was no path to a higher evaluation than 10% and that utilizing analogous coding for patellofemoral/retropatellar pain syndrome of 5299-5261 (analogous to limited leg extension) was the most medically appropriate code for the knee condition.  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 left knee 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 knee condition, the Board unanimously recommends a disability rating of 10%, coded 5299-5261 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 her prior medical separation:

UNFITTING CONDITION	VASRD CODE	RATING	
Left Knee Condition	5299-5261	10%	
COMBINED	10%	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20130918, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

		
XXXXXXXXXXXXXXXXXX
President
DoD 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 XXXXXXXXXXXXXXXXXX, AR20150008349 (PD201301530)

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						     XXXXXXXXXXXXXXXXXX
						     Deputy Assistant Secretary of the Army
						         (Review Boards)

CF: 
(  ) DoD PDBR
(  ) DVA