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AF | PDBR | CY2012 | PD2012 01599
Original file (PD2012 01599.rtf) Auto-classification: Denied
RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:    CASE: PD1201599
BRANCH OF SERVICE: Army  BOARD DATE: 20130717
SEPARATION DATE: 20020612


SUMMARY OF CASE: Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty SGT/E-5 (63B/Light-Wheel Vehicle Mechanic) medically separated for a left knee osteochondral dessicans lesion of the medial femoral condyle with osteoarthritis. The CI developed left knee pain in 1994 and underwent surgical procedures in 2000 and 2001. The CI’s 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). The left knee condition, characterized as “left knee osteochondral desiccans lesion medial femoral condyle with early osteoarthritis of the medial compartment along with varus malalignment” was forwarded to the Physical Evaluation Board (PEB) IAW AR 40-501. No other conditions were submitted by the MEB. The PEB adjudicated the referred left knee condition as unfitting, rated 10% citing criteria of the US Army Physical Disability Agency pain policy. The CI made no appeals and was medically separated.


CI CONTENTION: The CI elaborated no specific contention in his application.


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 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 20020319
 VA - (8 Mos. Post-Separation)
Condition
 Code Rating Condition Code Rating Exam
Left Knee Osteochondral Desiccans Lesion with Osteoarthritis 5299-5003 10% Post-Surgery, Left Knee with Osteoarthritic Changes 5010-5260 20% 20030206
No Additional MEB/PEB Entries
 Other x 3 20030206
Combined: 10%
 Combined: 20%
Derived from VA Rating Decision (VA RD ) dated 200 30414 ( most proximate to date of separation [ DOS ] ).



ANALYSIS SUMMARY:

Left Knee Condition. According to the MEB narrative summary report, the CI developed left knee pain in 1994, while stationed in Korea. There was no trauma history and the CI reported pain with running during physical training. The pain increased in intensity over the subsequent 6 years and in 2000, a large medial femoral condyle osteochondral dessicans lesion was diagnosed. In July 2000, the CI underwent arthroscopic fixation of the lesion followed by surgical removal of hardware 4 months later. As the pain persisted and the lesion did not heal well, in February 2001, a third procedure was performed (bone grafting of the lesion) followed again by hardware removal procedure in May 2001. The operative report from the last surgical procedure (May 2001) noted finding the articular cartilage over the lesion was soft but intact with minimal effusion of the left knee and scar tissue in the medial compartment. Examination at the time of surgery demonstrated full and symmetrical range-of-motion (ROM) without instability (negative Lachman’s, pivot, posterior drawer, varus or valgus stress or opening; normal anterior cruciate ligament). The CI continued to complain of medial knee pain, with inability to run, carrying equipment or traversing uneven terrain. Medication management, physical therapy and permanent profiling did not alleviate the pain and MEB was initiated. Physical therapy examination on 21 August 2001 evidenced a normal ROM for the left knee which was symmetric with the opposite knee (flexion 135 degrees and extension 0 degrees in both knees) with mildly decreased muscle strength of the left knee (4+/5) due to pain. At the MEB exam, performed on 21 November 2001, 7 months prior to separation, the CI reported slight left knee pain, exacerbated by standing more than 15 minutes and accompanied by swelling. The CI stated he could not run, jump or march. He was using an unloader brace which provided some relief. The MEB physical exam noted well healed surgical incisions of the left knee without effusion. There was marked tenderness along the medial joint line and medial femoral condyle. Left knee ROM was flexion of 135 degrees (symmetrical to the other side) and full extension with 3 degrees of hyperextension past 0 degrees (normal), also symmetric with the opposite knee. There was no joint instability. X-rays revealed the osteochondral lesion as well as early osteoarthritis of the medial compartment of the left knee. The MEB orthopedic specialist noted the CI condition was stable but would require specialized grafting surgery for improvement. At the VA Compensation and Pension (C&P) exam performed on 6 February 2003, 8 months after separation, the CI reported he underwent another surgery on his left knee in February 2002 but there are no details regarding this surgery. No operative report or post operative notes are available for review. Radiologic exam evidenced moderate degenerative joint disease (DJD) of the left knee. ROM evidenced extension of 0 degrees (with pain at 10 degrees) and flexion of 30 degrees. There was no ligamentar laxity or abnormal inspection of either knee. The CI was wearing a knee brace and his gait was normal.

The Board directs attention to its rating recommendation based on the above evidence. The PEB rated the left knee osteochondral desiccans lesion with osteoarthritis condition 10% coded 5299-5003 (degenerative arthritis). The VA adjudicated the left knee condition under code 5260 (limitation of flexion) and assigned a 20% rating citing the limited knee flexion of 30 degrees as evidenced by the C&P exam performed on 6 February 2003. The Board noted that according to the MEB physical exam performed 7 months prior to separation, there was no limitation of flexion or extension that attained a minimum rating (codes 6260 and 5261 respectively). There was not a dislocated meniscus with locking to support a minimum rating under 5258 (dislocated meniscus) and no surgical removal of a meniscus to warrant rating under 5259. The Board agreed a 10% rating was supported with application of §4.59 (painful motion) or §4.40 (functional impairment) due to DJD (5003). There was no injury to the tibia or fibula correlating with diagnostic code 5262. There was no ligamentar pathology, the orthopedic examination and the CI denied symptoms of instability. Therefore the Board conclude there not sufficient evidence for consideration of a rating under diagnostic code 5257 (other impairment, instability). The Board noted the report of an additional surgery in February 2002 just prior to the PEB however no records of that surgery were available for review. The Board noted the limitation of motion of the left knee at the time of the C&P examination, but also noted the CI qualified for and was hired as a federal prisons corrections officer, a position for which passing a physical abilities test is required which includes running one fourth of a mile, stair climbing up and down 100 steps, an obstacle course, and dragging a 75 pound dummy for a minimum distance of 694 feet (according to published standards). Subsequently, the CI reinjured his knee in his civilian job and was assigned administrative duties. C&P exam reports from 2005 and 2008 noted the ROM for the left knee improved but no more than 60 degrees of flexion. 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 osteochondral desiccans lesion with osteoarthritis 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. The Board did not surmise from the record or PEB ruling in this case that any prerogatives outside the VASRD were exercised. In the matter of the left knee osteochondral desiccans lesion with osteoarthritis 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
Osteochondral Dessicans Lesion with Osteoarthritis Condition
5299-5003 10%
COMBINED
 10%


The following documentary evidence was considered:

Exhibit A. DD Form 294, dated 20120727, 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 AR20130018487 (PD201201599)

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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