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AF | PDBR | CY2012 | PD2012 01479
Original file (PD2012 01479.rtf) Auto-classification: Denied
RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:    BRANCH OF SERVICE: Army
CASE NUMBER: PD1201479   BOARD DATE: 20130430
SEPARATIONDATE: 20020430


SUMMARY OF CASE: Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty SPC/E-4 (11M/Infantryman), medically separated for left knee residual pain. The CI developed knee pain in 2000. He underwent a left knee arthroscopy with medical meniscus debridement in November 2000 and then a second arthroscopy with resection of a medial plica in January 2001. Despite extensive conservative and surgical management, the CI did not improve adequately to meet the physical requirements of his Military Occupational Specialty (MOS) or satisfy physical fitness standards. He was issued a permanent L3 profile duty and referred for a Medical Evaluation Board (MEB). The left knee condition characterized as arthritis of the left knee, moderate was forwarded to the Physical Evaluation Board (PEB) IAW AR 40-501. The MEB forwarded no other conditions for PEB adjudication. The PEB adjudicated the left knee condition as unfitting, rated 10% with likely application of the Veteran’s Affairs Schedule for Rating Disabilities (VASRD). The CI made no appeals, and was medically separated with a 10% disability rating.
CI CONTENTION: The CI elaborated no specific contention in his application.


SCOPE OF REVIEW: The Board wishes to clarify that the scope of its review as defined in DoDI 6040.44, Enclosure 3, paragraph 5.e.(2) is limited to those conditions which were determined by the PEB to be specifically unfitting for continued military service; or, when requested by the CI, those condition(s) “identified but not determined to be unfitting by the PEB.” The ratings for unfitting conditions will be reviewed in all cases. Any conditions or contention not requested in this application, or otherwise outside the Board’s defined scope of review, remain eligible for future consideration by the Army Board for Correction of Military Records.


RATING COMPARISON :

Service IPEB – Dated 20020313
 VA– All Effective Date 20020501
Condition
 Code Rating Condition Code Rating Exam
Lt Knee Residual Pain S/P Arthroscopic Medial Meniscus Debridement 5259 10% Residuals Lt Knee Injury, Post Op 5257 10% STR
No Other MEB/PEB Entries
 Other x 13 STR
Combined: 10%
 Combined: 30%


ANALYSIS SUMMARY:

Left Knee Condition. The CI presented with left knee pain with running in 2000. He was treated with anti-inflammatory medications and physical therapy without resolution of his pain. In November 2000, the CI underwent a left knee arthroscopy with findings of a medial meniscus tear and Grade I femoral chondromalacia. A medial meniscus debridement was performed. Post-operatively, the CI continued to experience left knee pain and in 2001 he underwent a second arthroscopy with a medial plica debridement. At the time of the narrative summary (NARSUM), approximately 3 months prior to separation, the CI reported daily persistent pain in his left knee made worse with crawling, getting up from a sitting position, and going up and down stairs. The NARSUM physical examination demonstrated slightly decreased medial and lateral glide test, a borderline normal tilt test, and lateral retinaculum tenderness to palpation. There were no signs of cartilage impingement and no ligamental laxity to stress maneuvers in all planes. Meniscal maneuvers were normal.

There were three 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
 PT ~1 5 Mo. Pre-Sep PT ~ 6 1/2 Mo. Pre-Sep VA C&P ~ 7 Years Post-Sep
Flexion (140⁰ Normal)
 115 ⁰ 120 ⁰ 115 ⁰
Extension (0⁰ Normal)
 0 ⁰ #⁰ 0⁰
Comment
 N o pain + P atellofemoral glide, + increased pain with motion + Mc Murray’s, +painful motion
§4.71a Rating
 0% 1 0% 10%

The Board directs attention to its rating recommendation based on the above evidence. The PEB adjudicated the left knee condition as left knee residual pain at 10%, 5259 (Cartilage, semilunar, removal of, symptomatic). The VA also rated the left knee condition at 10%, coded 5257 (Knee, other impairment of: recurrent subluxation or lateral instability). A disability rating of 10% is the only rating attainable under VASRD codes 5259. The Board considered the 5257 code, which requires evidence of moderate knee subluxation or lateral laxity for a 20% disability rating. Board members agreed that there was no evidence of moderate knee subluxation or lateral laxity to support a 20% disability rating. After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the Board concluded that there was insufficient cause to recommend a change in the PEB adjudication for the left knee condition. The Board concluded therefore that this condition could not be recommended for additional disability rating.
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. In the matter of the 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 recharacterization of the CI’s disability and separation determination, as follows:
UNFITTING CONDITION
 VASRD CODE RATING
Lt Knee Residual Pain S/P Arthroscopic Medial Meniscus Debridement 5259 10%
COMBINED
 10%



The following documentary evidence was considered:

Exhibit A. DD Form 294, dated 20120620, 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 AR20130010810 (PD201201479)

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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