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AF | PDBR | CY2012 | PD2012 01525
Original file (PD2012 01525.rtf) Auto-classification: Approved
RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME: xxxxxxxxxxxxxxxxxx         CASE: PD1201525
BRANCH OF SERVICE: Army  BOARD DATE: 20130620
SEPARATION DATE: 20030515


SUMMARY OF CASE : Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty SGT/E-5 ( 75B20/Personnel Admin istration Specialist ) medically separated for left knee pain. H e twisted his left knee during Basic Training in 1997 and subsequently underwent arthroscopy in 1998 and 1999. He was diagnosed with retropatellar pain syndrome (RPPS) . He could not be adequately rehabilitated to meet the physical requirements of his M ilitary Occupational Specialty or satisfy physical fitness standards and was issued a permanent L3 profile , and referred for a Medical Evaluation Board (MEB). The MEB forwarded “ l eft knee retropatellar pain sy n drome ” to the Physical Evaluation Board (PEB) IAW AR 40-501 as not meeting retention standards . The MEB also forwarded two other conditions, charted below , as meeting retention standards . The PEB adjudicated “ l eft knee pain diagnosed as RPPS , with crepitus and patellar apprehension, no laxity, full range of motion ” as unfitting, rated 0 % , citing criteria of the US Army Physical Disability Agency (USAPDA) pain policy . The remaining conditions were determined to be not unfitting . The CI appealed the PEB determination and his case was referred to the USAPDA for review. The USAPDA affirmed the PEB adjudication. The CI was then separated .


CI CONTENTION: “Due to symptoms degenerative joint disease, which affected my range of motion, pain and stiffness, my condition of lower extremities was determined to be 30 percent disabling by the Department of Veterans Affairs. Additionally, my condition should have been rated bilaterally as determine with a 10 percent disabling rating. This condition has additionally caused recurrent problems with my lumbar spine.”


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. The requested right knee and lumbar spine conditions were not identified by the PEB, and thus are not within the DoDI 6040.44 defined purview of the Board. 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 Board for Correction of Military Records.


 RATING COMPARISON :

Service IPEB – Dated 20030117
 VA - (1 Mos. Post-Separation)
Condition
 Code Rating Condition Code Rating Exam
Left Knee…RPPS 5099-5003 0% Deg. Arthritis, Left Knee … 5010 10%* 200 30621
Hearing Loss Not Unfitting Bilateral Hearing Loss 6 1 00 NSC 20030621
S/P Strabismus Surgery… Not Unfitting S/P Strabismus Surgery … 6090 NSC 20030621
No Additional MEB/PEB Entries
 Other x 5 20030621
Combined: 0%
 Combined: 10%
Derived from VA Rating Decision (VA RD ) dated 200 30801 . * 20051208 VARD increased left knee to 30% effective 20051130
ANALYSIS SUMMARY: The Disability Evaluation System (DES) is responsible for maintaining a fit and vital fighting force. While the DES considers all of the member's medical conditions, compensation can only be offered for those medical conditions that cut short a member’s career, and then only to the degree of severity present at the time of final disposition. The DES has neither the role nor the authority to compensate members for anticipated future severity or potential complications of conditions resulting in medical separation nor for conditions determined to be service-connected by the Department of Veteran Affairs (DVA) but not determined to be unfitting by the PEB. However, the DVA, operating under a different set of laws (Title 38, United States Code), is empowered to compensate all service-connected conditions and to periodically re-evaluate said conditions for the purpose of adjusting the Veteran’s disability rating should the degree of impairment vary over time. The Board’s role is confined to the review of medical records and all evidence at hand to assess the fairness of PEB rating determinations, compared to Veterans Affairs Schedule for Rating Disabilities (VASRD) standards, based on severity at the time of separation.

Left Knee. The CI was initially evaluated due to a 3 week history left knee pain on 22 January 1996 after falling with his rucksack on. His examination was normal with the exception of tenderness to palpation (TTP) and one audible click, which was not reproducible. The CI was diagnosed with a medial collateral ligament strain, treated with Motrin and referred to physical therapy (PT). An magnetic resonance image scan performed on 9 March 1998 revealed high signal intensity in the posterior horn of the medial meniscus which was consistent with meniscal degeneration and question of meniscal tear. However, diagnostic arthroscopy of the left knee on 7 May 1998 revealed an essentially normal knee. An orthopedic note dated 21 January 1999 noted that the CI reported some improvement following surgery, but his pain returned with increased activity. The examiner noted atrophy of the quadriceps and a small mass that was thought to be plica (protective synovial capsule of the knee) in the medial retinacular area of the left knee. A second arthroscopic surgery on 29 October 1999 revealed “a medial plica exuding down from the medial eminence of the knee” which was excised. An orthopedic note dated 17 March 2000 reported that the CI reported that his knee condition was back to where it had been prior to surgery. The examiner noted that the CI had been lost to follow-up and had discontinued PT on his own. The narrative summary dated 1 November 2002 noted that the CI had a 6 year history of persistent knee pain despite conservative and surgical treatment. At the MEB examination, the CI reported complaints of knee pain during most activities of daily living. The MEB examiner noted the left knee was TTP along the medial joint line and the medial femoral condyle. There was no tenderness present about the patella, lateral border, patellar tendon, or insertion of the tibial tubercle. The knee was stable with negative Lachman, anterior drawer, varus, and valgus testing. McMurray’s test for meniscal irritation was negative. There was a positive patellar grind and patellar apprehension (consistent with RPPS). Muscle strength was normal. X-rays showed minimal osteoarthritis and a bone scan in April 2001 showed increased uptake with the medial femoral condyle and bilateral tibial plateaus. At the VA Compensation and Pension (C&P) exam performed a month after separation, the CI reported that he had fairly constant pain rated 3/10. He reported having flare-ups about once a week “decreasing his motion about 25%.” The pain was in the anteromedial portion of the knee and was worse with prolonged sitting, walking, ascending and descending stairs, and walking up inclines. The pain improved with rest. The examiner noted an antalgic gait on the left and that the CI was wearing a knee brace. Range-of-motion (ROM) exam is shown in the chart below. There was no joint effusion present. There was minimal tenderness around the patella. There was no medial or lateral joint line tenderness. The knee was stable with varus and valgus stress at 0 and 130 degrees. There was a negative Lachman, anterior drawer, posterior drawer, and posterolateral corner test. Muscle strength and sensory examination were normal. X-rays showed mild medial joint space narrowing with weight bearing. The goniometric 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.
Left Knee ROM (Degrees)
MEB ~ 6 Mo. Pre-Sep VA C&P ~ 1 Mo. Post-Sep
Flexion (140 Normal)
 130 140
Extension (0 Normal)
 0 0
Comment
 No pain with ROM noted. Pain- free full arch.
§4.71a Rating
 0 % 0 %

The Board directs attention to its rating recommendation based on the above evidence. The PEB coded the left knee condition analogously to the degenerative arthritis code, 5003, and assigned a 0% disability rating. The VA coded the left knee condition 5010, arthritis due to trauma, and assigned a 10% rating. Both VASRD codes, 5003 and 5010, use the same rating criteria. The ROM measurements for the left knee condition were non-compensable under the VASRD diagnostic codes for limitation of motion (5260 and 5261), and there was no instability or meniscus problems to warrant rating under the respective codes (5257, 5258, 5259). The Board considered whether a minimum rating was supported with application of §4.59 (painful motion) or §4.40 (functional loss). The Board noted that there was no pain on ROM testing on either the MEB or C&P examinations; however, both examinations made reference to tenderness about the patella and noted pain with activity implying painful motion. 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 left knee condition, coded 5010.


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 unanimously recommends a disability rating of 10%, coded 5010 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:

UNFITTING CONDITION
 VASRD CODE RATING
Degenerative Arthritis, Left Knee, Status Post Arthroscopies 5010 10%
COMBINED
 10%


The following documentary evidence was considered:

Exhibit A. DD Form 294, dated 20120815, w/atchs
Exhibit B. Service Treatment Record
Exhibit C. Department of Veterans’ Affairs Treatment Record





xxxxxxxxxxxxxxxxxxxxxx, DAF
President
Physical Disability Board of Review

SFMR-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 xxxxxxxxxxxxxxxxxxxxxxxx, AR20140001330 (PD201201525)


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                                                  xxxxxxxxxxxxxxxxxxxxxxxxx
                                                      Deputy Assistant Secretary
                                                      (Army Review Boards)


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