RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXX	CASE:  PD-2014-00139
BRANCH OF SERVICE:  Army	BOARD DATE:  20141212
SEPARATION DATE:  20080109

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E-6 (Corrections Specialist) medically separated for a left knee condition.  The knee condition could not be adequately rehabilitated to meet the physical requirements of his Military Occupational Specialty or satisfy physical fitness standards.  He was issued a permanent L3 profile and referred for a Medical Evaluation Board (MEB).  Continued and chronic left lateral-sided knee pain was forwarded to the Physical Evaluation Board (PEB) IAW AR 40-501.  The MEB also identified and forwarded one other condition (chronic bilateral hearing loss) for PEB adjudication.  The Informal PEB adjudicated “chronic left knee pain” as unfitting, rated 10% citing criteria of the US Army Physical Disability Agency (USAPDA) pain policy.  The remaining condition was determined to be not unfitting.  The CI made no appeals and was medically separated.

CI CONTENTION:  “I was an MP and after my injury could not function as one.  I told my MEB person who was handling my case that I felt my rating was wrong.  I was never debriefed or re-integrated … never asked about my PTSD, my knee, and the two surgeries … cannot function normally because of my knee, I still endure pain.  I wear a brace to this day.”  

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:

Service  IPEB – Dated 20071005 | VA - (<1 Mo. Post-Separation)
Condition | Code | Rating | Condition | Code | Rating | Exam
Chronic Left Knee Pain | 5099-5003 | 10% | Left Knee, Torn Medial Meniscus… | 5010 | 0% | 20080122
Other x 1  (Not in Scope) | Other x 5
Rating:  10% | Combined Rating:  30%
Derived from VA Rating Decision (VARD) dated 20080519 (most proximate to date of separation [DOS]).

ANALYSIS SUMMARY:

Chronic Left Knee Condition.  The narrative summary (NARSUM), approximately 5 months prior to separation, noted the CI complained of left knee pain since an injury in 2002.  He had additional injuries and underwent two surgeries where he had iliotibial band resection, removal of inflamed joint linings (bursectomy and debridement of synovitis) and repair of a meniscal tear.  His left knee pain continued following his surgeries.  His pain was constant and he was taking narcotic pain medications that limited his activity.  He had intermittent giving way, but continued to deny swelling and locking of the knee.  On exam, he had full range-of-motion (ROM), was neurovascularly intact and his ligaments were stable.  He had notable pain with McMurray’s exam (for meniscal pathology) and deep bending.  Radiographs were “unremarkable.”  On the NARSUM addendum exam, approximately 3 months prior to separation, he was noted to ambulate with no apparent pain and no limp noted.  On active ROM, left knee flexion was 125 degrees (limited by pain-normal 140 degrees) and extension was 0 degrees.  The DD Form 2808, dated the day of the NARSUM addendum (and by the same examiner), documented tenderness to palpation, no effusion, no crepitus or grinding and stable ligaments.  The associated DD Form 2807 indicated that the CI complained of knee swelling with continuous walking, running, etc.

At the VA Compensation and Pension exam performed 2 weeks after separation, the CI reported that he was able to stand for 30 minutes, walk for 1-3 miles, but had continued pain, a sensation of giving way and complained of locking several times a week.  He denied effusion, weakness, dislocation or instability.  The exam was notable for a normal gait, 0-140 degrees ROM (normal) with no additional loss or pain on repetition (negative DeLuca), negative Lachman’s and McMurray’s bilaterally and stable ligament exam without effusions.  X-rays were normal.

The Board directed attention to its rating recommendation based on the above evidence.  The PEB assigned a 10% rating under code 5099-5003 per the USAPDA pain policy.  The VA granted service-connection and assigned a 0% rating coded 5010 (Arthritis, due to trauma, substantiated by X-ray findings).  All exams in evidence documented either painful motion or complaints of knee symptoms following meniscal surgery that would warrant a 10% rating.  There was no objective evidence of instability for dual coding of the knees and meniscal coding includes painful motion.  The Board considered a possible 20% rating analogous to code 5258 (with frequent episodes of “locking,” pain, and effusion into the joint); however, there was insufficient evidence for that higher rating.  Ideal coding at separation would have been analogous to 5259 (cartilage, semilunar, removal of, symptomatic) with a rating of 10%.  However this alternate coding would have been of no benefit to the CI and analogous coding to 5003 (arthritis, degenerative [hypertrophic or osteoarthritis]) was supported by the NARSUM addendum exam.

After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the Board concluded there was insufficient cause to recommend a change in the PEB adjudication 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.  As discussed above, PEB reliance on the USAPDA pain policy for rating the left knee was operant in this case and the condition was adjudicated independently of that policy by the Board.  In the matter of the left knee condition, the Board 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 there be no re-characterization of the CI’s disability and separation determination.

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 201, 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 XXXXXXXXXXXXXXX, AR20150008499 (PD201400139)

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			     XXXXXXXXXXXXXXX
			     Deputy Assistant Secretary of the Army
			          (Review Boards)
						         
CF: 
(  ) DoD PDBR
(  ) DVA

PD-2014-00139