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AF | PDBR | CY2012 | PD2012 01300
Original file (PD2012 01300.rtf) Auto-classification: Denied
RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:    CASE: PD1201300
BRANCH OF SERVICE: Army  BOARD DATE: 20130724
SEPARATION DATE: 20020217


SUMMARY OF CASE: Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty SPC/E-4 (68X/Helicopter Avionics Repairman) medically separated for chronic left knee pain due to chondromalacia. The CI injured his left knee in April of 2000 while skateboarding. The knee pain continued and the CI eventually had a left knee arthroscopy in January 2001. His pain persisted and he was unable to return to his full occupation in his military specialty. His left knee 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). The left knee condition, characterized as “left knee chondromalacia” was forwarded to the Physical Evaluation Board (PEB) IAW AR 40-501. No other conditions were submitted by the MEB. The PEB adjudicated “chronic pain, left knee due to chondromalacia” as unfitting, rated 10%, citing application of the US Army Physical Disability Agency (USAPDA) pain policy. The CI made no appeals and was medically separated.


CI CONTENTION: “I have two conditions that continue to worsen.”


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, and no additional conditions are within the DoDI 6040.44 defined purview of the Board. Any conditions or contention either not requested in this application or otherwise outside the Board’s defined scope of review remain eligible for future consideration by the Board for Correction of Military Records.


 RATING COMPARISON :

Service IIPEB – Dated 20011201
 VA
Condition
 Code Rating Condition Code Rating Exam
Chronic Pain, Left Knee due to Chondromalacia 5299-5003 10% Left Knee Chondromalacia Unknown 10% Unknown
No Additional MEB/PEB Entries
 Other x 1
Rating: 10%
 Combined: 20%
Derived from original VA Rating Decision (VA RD ) effective 18 February 2002 ( most proximate to date of separation [ DOS ] ).


ANALYSIS SUMMARY: The Board acknowledges the CI’s information regarding the significant impairment with which his service-connected condition continues to burden him but, must emphasize that the Disability Evaluation System has neither the role nor the authority to compensate members for anticipated future severity or potential complications of conditions resulting in medical separation. That role and authority is granted by Congress to the Department of Veterans Affairs, operating under a different set of laws.

Chronic Pain, Left Knee due to Chondromalacia Condition. The goniometric range-of-motion (ROM) evaluations in evidence which the Board weighed in arriving at its rating recommendation, with documentation of additional ratable criteria, are summarized in the chart below.
invalid font number 31502
Left Knee ROM
 MEB ~6 Mo. Pre-Sep aration VA C&P ~7 Years Post-Sep aration
Flexion (140⁰ Normal)
 135⁰ 105°
Extension (0⁰ Normal)
 0⁰ 0°
Comment
 No effusion; no patellofemoral crepitus; n ormal patellar tracking with a negative J-sign ; n ega tive patellar apprehension test; n o medial or lateral joint line tenderness; no varus or valgus instability; n egative Lachman; negative pivot shift test “Objective evidence of pain with motion but no additional limitation of motion after repetitive use;” gait involved poor propulsion and leaning to the right; crepitus, tenderness, pain at rest, and abnormal motion;
§4.71a Rating
 10% 10%

The CI injured his left knee while skateboarding in April 2000. Initial X-rays were negative and the CI was treated conservatively, including a brace, prior to a move to Korea. While in Korea, the CI was evaluated by orthopedics and an arthroscopy of the left knee was performed in January 2001 for a possible medial meniscal tear. However, the post-operative diagnoses were left knee chondral fracture of the medial femoral condyle, weight bearing portion and Grade II chondromalacia. The CI continued to have symptoms of an inability to run, pain with prolonged standing, and a feeling the knee would give out medially and he was referred to orthopedics in June 2001 after returning from Korea. X-rays performed in August 2001 were normal but the CI continued to have symptoms. A permanent L3 profile was issued with restrictions of no running, jumping, road marching, climbing, or crawling; no wearing a backpack; and no two-mile run or alternate aerobic event for the Army Physical fitness Test. The commander’s statement noted the physical demands of the CI’s MOS were categorized as heavy and the CI was not able to perform all the required tasks. The MEB narrative summary (NARSUM) completed by orthopedics approximately 6 months prior to separation noted that after the arthroscopy, the CI was unable to return to a full occupation in his military specialty. The physical examination findings are recorded in the chart above. A MEB history and physical was completed the same day by a different provider and it noted moderate crepitance of the left knee with full flexion. Neither the initial VA Compensation and Pension (C&P) exam completed near the time of separation, nor the initial VA rating decision (VARD), were available for Board review. However, the CI filed a claim for increased evaluation in February 2009 and while the C&P examination completed on 21 May 2009 was not available, the VARD from that time was available for Board review and it described the May 2009 examination and indicated the original effective date and initial disability rating for the left knee condition. This examination documented painful motion and flexion limited to 105 degrees. While this examination was completed more than 7 years after separation, the initial 10% rating was continued.

The Board directs attention to its rating recommendation based on the above evidence. The PEB coded the condition analogous to 5003 arthritis, degenerative (hypertrophic or osteoarthritis) and rated 10%. Due to missing documents, the Board was not able to determine the Veterans Affairs Schedule for Rating Disabilities (VASRD) code used by the VA but the record indicates the VA also rated the condition at 10%. While the MEB NARSUM examination documented pain-limited motion, it was not at a compensable level. However, §4.59 states that it is the intention of the VASRD to recognize actually painful, unstable, or malaligned joints, due to healed injury, as entitled to at least the minimum compensable rating for the joint. Additionally VASRD code 5003 states that when the limitation of motion of a specific joint or joints involved is noncompensable under the appropriate diagnostic codes, a rating of 10 percent is applied to each such major joint or group of minor joints affected by limitation of motion which is objectively confirmed by findings such as swelling, muscle spasm, or satisfactory evidence of painful motion. Neither the Service nor VA evidence indicated the presence of ligamentous laxity, frequent effusions, or locking. There is therefore no VASRD §4.71a route to a rating higher than 10% under any applicable code, and no grounds for additional rating of instability. After due deliberation, considering all of the evidence and mindful of VASRD §4.3 reasonable doubt and §4.59 (painful motion) the Board concluded that there was insufficient cause to recommend a change in the PEB adjudication for the chronic pain, left knee due to chondromalacia 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 was operant in this case and the condition was adjudicated independently of that policy by the Board. In the matter of the chronic pain, left knee due to chondromalacia 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 recharacterization of the CI’s disability and separation determination, as follows:

UNFITTING CONDITION
 VASRD CODE RATING
Chronic Pain, Left Knee due to Chondromalacia 5299-5003 10%
RATING
 10%


The following documentary evidence was considered:

Exhibit A. DD Form 294, dated 20120625, w/atchs
Exhibit B. Service Treatment Record
Exhibit C. Department of Veterans’ Affairs Treatment Record




Physical Disability Board of Review


 SFMR-RB                                                                         


MEMORANDUM FOR Commander, US Army Physical Disability Agency
(TAPD-ZB),


SUBJECT: Department of Defense Physical Disability Board of Review Recommendation for AR20130018486 (PD201201300)

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                                                 
                                                      (Army Review Boards)

CF:
( ) DoD PDBR
( ) DVA

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