RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXXX	CASE:  PD-2013-01737
BRANCH OF SERVICE:  Army	BOARD DATE:  20150318
SEPARATION DATE:  20050822

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E-4 (Computer Systems Analyst) medically separated for chronic left knee pain.  The left knee condition could not be adequately rehabilitated to meet the physical requirements of his Military Occupational Specialty but was authorized to perform an alternate physical fitness test.   He was issued a permanent L3 profile and referred for a Medical Evaluation Board (MEB).  The “left knee lateral meniscus tear repair with persistent anterior knee pain,” was forwarded to the Physical Evaluation Board (PEB) IAW AR 40-501.  No other condition was submitted by the MEB.  The Informal PEB adjudicated “chronic left knee pain status post meniscal repair,” as unfitting, rated 0%, citing application of the US Army Physical Disability Agency (USAPDA) pain policy.  The CI made no appeals and was medically separated.  

CI CONTENTION:  His condition continues to worsen and negatively impact his daily activities.  His complete submission is at Exhibit A.

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/Naval 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:  

IPEB – Dated 20050511 | VA* - (~1Mos. Pre-Separation)
Condition | Code | Rating | Condition | Code | Rating | Exam
Chronic Left Knee Pain Status Post Meniscal Repair | 5099-5003 | 0% | Postoperative Residuals, Left Knee lateral Meniscal Tear Repair | 5259 | 10% | 20050727
Other x 0 (Not In Scope) | Other x 7 (equals SC, NSC & deferred)
RATING:  0% | RATING:  20%
*Derived from VA Rating Decision (VARD) dated 20051017 (most proximate to date of separation [DOS]).  

ANALYSIS SUMMARY:  

Chronic Left Knee Pain.  The narrative summary noted that during deployment the CI injured his knee lifting weights and aggravated it a few weeks later while playing basketball.  Conservative treatment did not improve his symptoms and notes in the service treatment record indicated that magnetic resonance imaging MRI) of the left knee showed meniscal tears.  The CI had surgery 16 September 2004 for lateral meniscal tear (LMT) repair.  Following the surgery the CI continued to have anterior left knee pain and despite physical therapy the CI was unable to return to impact activities.  An orthopedic note 4 March 2005 indicated that the CI requested to have a MEB initiated for the knee condition and the exam noted tenderness of the anterior knee, without swelling or instability, with a diagnosis of residual patellofemoral syndrome.  The examiner ordered another MRI, but there was no documentation in record that it was performed.  At the orthopedic follow-up visit a few weeks later, a MEB was initiated for incomplete return to duty after LMT repair.  At the MEB examination performed on 20 April 2005, 4 months prior to separation, the CI reported knee pain that limited his ability to run, jump, march, or squat.  The MEB physical exam noted anterior knee tenderness without an effusion.  Left knee range-of-motion (ROM) was 0-135 degrees (normal 0-140) and the knee was stable, with good muscle tone.

At the VA Compensation and Pension (C&P) examination 27 July 2005, a month before separation, the CI reported knee pain with crepitus with activity and occasional swelling, locking, and instability.  He reported using daily anti-inflammatory medication and as needed pain medication.  On exam there was a normal gait, without swelling, tenderness, or effusion of the knee.  There was full ROM with crepitus, without evidence of instability or symptoms due to cartilage injury.  Strength, sensation, and reflexes were noted to be normal.  Left knee X-rays taken on 27 July 2005 were normal, without significant degenerative changes noted.  There was no evidence of painful motion or additional limitation of ROM following repetition.  At a VA C&P Joints examination performed on 4 August 2006, 12 months after separation, the CI reported frequent locking and swelling of the left knee.  There was swelling and crepitus of the left knee on exam and ROM was 0-95 degrees, with additional loss of 5 degrees due to pain.  There was no evidence of instability or semilunar cartilage symptoms with testing.  

The Board directed its attention to its rating recommendation based on the above evidence.  The PEB rated the knee condition 0%, coded 5099-5003 (analogous to degenerative arthritis), and cited the USAPDA pain policy.  The VA initially rated the knee condition 10%, coded 5259 for symptomatic semilunar cartilage status post removal.  The VA rating was increased to 20% following the C&P examination 4 August 2006.  Board consensus was that at the time of separation the evidence in record supported a 10% rating IAW VASRD §4.59 (Painful motion) and §4.45 (The joints), which note that “it is the intention to recognize actually painful joints…due to healed injury as entitled to at least the minimum compensable rating for the joint” and “factors of disability…considerations” include “pain on movement” and “interference with…weight bearing”.  The Board reviewed to see if a higher evaluation was achieved with any applicable code.  There was no evidence of limited ROM based on ROM alone; ankylosis; or, impairment of the femur, tibia, or fibula to provide a higher rating.  At the C&P examination 12 months after separation, the CI reported frequent locking and giving way of his knee, but there was no evidence of semilunar cartilage related symptoms on exam.  Additionally, the Board considered if there was evidence to support separate rating for instability and limited ROM in this case, however, the knee was noted to be stable at both the MEB and C&P exams.  Members agreed that coding as 5259 was medically appropriate in this case and that at separation the disability due to the knee condition met the 10% rating.  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 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.  As discussed above, PEB reliance on the USAPDA pain policy for rating the knee condition was operant in this case and the condition was adjudicated independently of that policy by this Board.  In the matter of the left knee condition, the Board unanimously recommends a disability rating of 10%, coded 5259 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:  

CONDITION | VASRD CODE | RATING
Chronic Left Knee Pain Condition | 5259 | 10%
RATING | 10%

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20131023, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

XXXXXXXXXXXXXXX 
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 XXXXXXXXXXXXXXXXXXXX, AR20150015862 (PD201301737)

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						     XXXXXXXXXXXXXXXXXXXX
						     Deputy Assistant Secretary of the Army
						         (Review Boards)

CF: 
(  ) DoD PDBR
(  ) DVA

PD-2013-01737