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AF | PDBR | CY2012 | PD 2012 01140
Original file (PD 2012 01140.rtf) Auto-classification: Denied
RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME: XXXXXXXXXXXXXX      CASE: PD -20 12 - 0 1140
BRANCH OF SERVICE: Army   BOARD DATE: 2014 0819
Separation Date: 20020710


SUMMARY OF CASE : Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty PVT/E-1 (19K00/M1 Armor Crewman) medically separated for a left knee condition. This 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). Left knee patellofemoral syndrome (PFPS) was forwarded to the Physical Evaluation Board (PEB) IAW AR 40-501. No other condition was submitted by the MEB. The Informal PEB adjudicated PFPS, left knee as unfitting, rated 10%, with cited application of the US Army Physical Disability Agency (USAPDA) pain policy. The CI made no appeals and was medically separated.


CI CONTENTION : “Please consider all conditions.”


 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 left knee condition is addressed below. Any other condition or contention not requested in this application, remain eligible for future consideration by the Board for Correction of Military Records.

IAW DoDI 6040.44, the Board’s authority is limited to making recommendations on correcting disability determinations. The Board’s role is thus confined to the review of medical records and all evidence at hand to assess the fairness of PEB rating determinations, compared to the VA Schedule for Rating Disabilities (VASRD) standards, based on ratable severity at the time of separation.


 RATING COMPARISON :

Service IPEB – Dated 20020614
 VA* - based on Service Treatment Records (STR)
Condition
 Code Rating Condition Code Rating Exam
Patellofemoral Pain Syndrome, Left Knee 5099-5003 10% Patellofemoral Pain Syndrome, Left Knee 5099-5014 10% Service Treatment Record (STR)
No Additional MEB/PEB Entries
 Other x0 STR
Combined: 10%
 Combined: 10%
* Derived from VA Rating Decision (VARD) dated 20020712 (most proximate to date of separation (DOS))


ANALYSIS SUMMARY :

Patellofemoral Pain Syndrome, Left Knee Condition . There were 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)
Ortho 3 Mo s . Pre-Sep Ortho 2 Mo s . Pre-Sep NARSUM 1. 5 Mo s . Pre-Sep
Flexion (140 Normal)
 140 “ Full Active ROM ” “ Full Active ROM ”
Extension (0 Normal)
 0 “ Full Active ROM ” “ Full Active ROM ”
Comment
 Pos. tender to palpation (TTP); Pos. crepitus; No instability or effusion Pos. TTP patella tendon; No instability or effusion; Pos. crepitus Pos. patell ar compression & TT P over patellar tendon / medial tibial plateau; No instability
§4.71a Rating
 10 % 10 % 10 %

The CI injured his left knee during basic training when he lifted sandbags in a pit on the obstacle course and banged his left knee on the ground. He was seen in acute c are a week later when he twisted his left knee. The physical exam findings were tenderness to palpation ( TTP ) , slight erythema, mild edema and full ROM with pain. The examiner di agn osed left knee sprain and advised no running, jumping or marching for 3 days, and Tylenol as needed. A left knee X -ray was normal. A bone scan performed demonstrated an increased uptake in the right joint surfaces which indicated overuse and there w ere no stress fracture s noted . The CI was seen by o rthopedics who documented sharp pain rated at 8/10 w h i ch increased to 9/10 with walking and stair climbing. The physical exam findings are summarized in the chart above . The examiner diagnosed PFPS and ordered a knee brace, physical therapy and a p rofile. The o rthopedic follow-up visit indicated continued knee symptoms and t he physical exam findings are summarized in the chart above. The commander’s statement noted that the CI’s knee prevented him from performing his MOS duties. The MEB n arrative s ummary (NARSUM) exam approximately 2 months prior to separation documented that the CI reported that most of the sharp pain was located under the knee cap and was increased with walking, running and climbing stairs. The CI also had constant pain and occasional popping; however there were no episodes of giving away. T he MEB NARSUM physical exam findings are summarized in the chart above. The CI was given a permanent L3 Profile for left knee PFS with additional restrictions of no running, jumping, ru ck ing or marching.

The CI did not undergo a VA Compensation and Pension exam. A left knee MRI performed 8 months after separation showed degenerative changes of the posterior horns of both the medial and lateral menisci; however no acute tear wa s seen.

The Board directs attenti on to its rating recommendation based on the above evidence . The PEB coded the PFPS, left knee condition as 5099 analogous to 5003 ( degenerative a rthritis ) and rated at 10% citing application of the USPADA p ain p olicy . The VA coded the PFPS, left knee condition as 5099 analogous to 5014 ( o steomalacia ) r ated at 10%. The VA based their rating on the STR citing, “…because you have pain in your knee while walking and there is tenderness to palpation . ” The VA chose a different coding option for the knee condition; however, the 5014 code is rated under 5003 IAW §4.71a. All exams proximate to separation documented pain ful motion without any instability , limited ROM to a compensable level without application of §4.59 Painful motion or incapacitating episodes . The meniscal changes documented by MRI, 8  months after separation, would also generate a 10% rating due to “slight” knee disability. VASRD §4.71a specifies for code 5003 that satisfactory evidence of painful motion limitation of motion and specifies a 10% rating for each major joint or group of minor joints affected by limitation of motion. After due deliberation, considering all of the evid ence and mindful of VASRD §4.3 r easonable doubt, the Board concluded that there was insufficient cause to recommend a change in the PEB adjudication for the PFPS, 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 rati ng patellofemoral pain syndrome, left knee condition was operant in this case and the condition was adjudicated independently of that policy by the Board. In the matter of the patellofemoral pain syndrome, left knee condition and IAW VASRD §4.71a, the Board unanimously 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 that 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 20 140425 , w/atchs
Exhib it B. Service Treatment Record
Exhibit C. Department of Veterans ’ Affairs Treatment Record



                          
XXXXXXXXXXXXXX
P resident
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 XXXXXXXXXXXXXX, AR20150003037 (PD201301140)


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

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