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AF | PDBR | CY2012 | PD2012 01781
Original file (PD2012 01781.rtf) Auto-classification: Approved
RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:             BRANCH OF SERVICE: army
CASE NUMBER: PD1201781   SEPARATION DATE: 20040120
BOARD DATE: 20130404


SUMMARY OF CASE: Data extracted from the available evidence of record reflects that this covered individual (CI) was a Reserve member, SGT/E-5 (31U/Signal Support System Specialist), medically separated for right knee pain secondary to chondromalacia of the lateral tibial plateau and patella and right medial and lateral meniscal tears. The CI underwent surgery and physical therapy, however the right knee could not be adequately rehabilitated to meet the physical requirements of his Military Occupational Specialty (MOS) or satisfy physical fitness standards. He was consequently issued a permanent P3 profile and referred for a Medical Evaluation Board (MEB). The right knee pain, characterized as “right knee pain secondary to chondromalacia of the lateral tibial plateau and patella, status post arthroscopic debridement of medial and lateral meniscus tears,” was forwarded to the Physical Evaluation Board (PEB) as medically unacceptable IAW AR 40-501. Essential hypertension and overweight conditions were addressed by the MEB, and forwarded as medically acceptable. The PEB adjudicated the right knee pain as unfitting, rated 0%, with likely application of the Veterans Affairs Schedule for Rating Disabilities (VASRD). The remaining conditions were determined to be not unfitting. The CI made no appeals, and was medically separated with that disability rating.


CI CONTENTION: “Since I was injured in Iraq I have underwent one surgery at Fort Leonardwood and two more surgeries at the Iowa City VA Hospital. I have severe chondromalacia and am unable to do a lot of the normal daily activities due to Pain, swelling and discomfort. The VA doctors have informed me that I will need an artificial knee in the years to come due to the injury.” (sic)


SCOPE OF REVIEW: The Board wishes to clarify that the scope of its review as defined in Department of Defense Instruction (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 rating for the unfitting right knee condition is addressed below. The essential hypertension and overweight conditions were not alluded to in the application and are not judged to have been requested; e.g., they do not satisfy scope requirements. 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 Service Department Board for Correction of Military Records.


RATING COMPARISON:

Service IPEB – Dated 20031205
 VA (# Mo. Post-Separation) – Effective 20040121
Condition
 Code Rating Condition Code Rating Exam
Right Knee Pain Secondary to Chondromalacia of the Lateral Tibial Plateau and Patella
 5099-5003 0% Status Post Right Knee Arthroscopy with Chondromalacia 5258* 20% 20040810
↓No Additional MEB/PEB Entries↓
 Post Traumatic Stress Disorder 9411 30% 20040810
Tinnitus 6260 10% 20040810
Hypertension 7101 10% 20040810
0% X 1 / Not Service Connected x 1
Combined: 0%
 Combined: 60%
* I ncreased to 100% from 20040811 (post surgery convalescence ), th en reduced to 20% from 20041201; then increased to 100% from 20100107 (post surgery /treatment convalescence), then reduced to 20% from 20100301

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 VASRD standards, based on severity at the time of separation.

Right Knee Pain Secondary to Chondromalacia Condition. The CI twisted his right knee while deployed in June 2003 when he jumped out of the back of a vehicle and landed on rocks. Magnetic resonance imaging (MRI) in July 2003 demonstrated medial meniscus tear and the CI underwent arthroscopic surgery on 3 September 2003. At surgery the orthopedist debrided the medial and lateral meniscus and also discovered Grade 2 chondromalacia of the right patellofemoral joint. The CI improved with physical therapy after surgery, but he continued to have recurrent effusion, grinding in the knee, and difficulty with walking, running, prolonged standing, and going on stairs. At the orthopedic MEB NARSUM evaluation, 5 November 2003, 2 months after surgery and 2 months prior to separation, the right knee range-of-motion was extension 3 degrees and flexion 128 degrees. His knee joint was completely stable. There was a trace effusion in the knee. There was no joint tenderness. The examiner concluded that the CI was unable to meet the requirements of his military duties. At the VA Compensation and Pension (C&P) examination on 10 August 2004 (7 months post-separation), was extension “a little less than 10 degrees” attaining further extension on active ROM testing, and flexion 115 degrees. There was painful motion present. The CI underwent another surgery in August 2004 7 months following separation with findings of chondromalacia.

The Board directs attention to its rating recommendation based on the above evidence. The PEB rated 0% rated analogously to degenerative arthritis (5099-5003) citing the absence of significant loss of joint motion and absence of instability. The VA rated 20% coded 5258 (dislocated meniscus) citing presence of recurrent effusion post-separation. The Board determined that the CI would rate 0 percent under 5257 (knee instability), 5260 (limitation of flexion), and 5261 (limitation of extension). Although the CI did have mild effusion pre-separation, there was no evidence of a dislocated meniscus or documentation of frequent locking to support the 20% rating under 5258 (cartilage dislocation). The Board then considered application of VASRD §4.59 (painful motion) and §4.40 (functional loss). Although the CI did not have painful motion at the prior to separation MEB examination, the Board notes there was ample evidence pre-separation and at the post-separation C&P exam of painful motion that a 10% rating was reasonably supported. A rating of 10% was also supported under 5259 (symptomatic after removal of semi-lunar cartilage) but provided no benefit. 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 right knee pain 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 right knee pain condition, the Board unanimously recommends a disability rating of 10%, coded 5099-5003, 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
Right Knee Pain Secondary to Chondromalacia of Tibial Plateau
 5099-5003 10%
COMBINED
 10%


The following documentary evidence was considered:

Exhibit A. DD Form 294, dated 20121001, 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 AR20130009608 (PD201201781)
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                                                 
                                                      (Army Review Boards)

CF:
( ) DoD PDBR
( ) DVA

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