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AF | PDBR | CY2012 | PD2012 01982
Original file (PD2012 01982.rtf) Auto-classification: Denied
RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:    CASE: PD1201982        
BRANCH OF SERVICE: Army  BOARD DATE: 20130430
SEPARATION DATE: 20090414                


SUMMARY OF CASE: Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty SGT/E-5 ( 63B20 / Wheeled Vehicle Mechanic ) medically separated for left knee pain . Onset of his injury was in 1998 while playing football prior to active duty . He had arthroscopic surgery and was asymptomatic until April 2005 when he suffered exacerbations while deployed to Iraq. He was diagnosed with media l compartment meniscus tears and tricompartmental degenerative joint disease ( DJD ) , and underwent another arthroscopic surgery in 2007. The left knee 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 pain and osteoarthritis, status post (s/p) arthroscopic debridement ” was forwarded to the Physical Evaluation Board (PEB) IAW AR   40-501. The MEB also identified and forwarded three other conditions (see rating chart below) for PEB adjudication. The PEB adjudicated “ t ricompartmental osteoarthritis left knee w ith meniscal tear/degeneration ” as unfitting, rated 10 % citing criteria of the Veterans A ffairs Schedule for Rating Disabilities (VASRD) . The PEB adjudicated the three other conditions, obesity, hypertension, and allergic rhinosinusitis as not unfitting. The CI made no appeals, and was medically separated with a 10% disability rating.


CI CONTENTION: “Requesting change in status for percentage awarded. Removed from active duty from injuries occurred and verified in Iraq.”


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 service 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 respective Service Board for Correction of Military Records.


RATING COMPARISON:

Service IPEB – Dated 20090102
 VA - (2 Mos. Pre-Separation)
Condition
 Code Rating Condition Code Rating Exam
Tricompartmental Osteoarthritis Left Knee with Meniscal Tear/ Degeneration
 5003 10% Status Post Surgery, Left Knee with Degenerative Changes, Bilateral Knees 5003 10% 20090220
Scars, Left Knee 7805 0% 20090220
Obesity
 Not Unfitting No VA Entry
Hypertension
 Not Unfitting Hypertension 7101 0% 20090220
Allergic Rhinosinusitis
 Not Unfitting Allergic Rhinitis 6522 0% 20090220
No Additional MEB/PEB Entries
 Other x 6 20090220
Combined: 10%
 Combined: 60%
Derived from VA Rating Decision (VA RD ) dated 200 90514 ( most proximate to date of separation [ DOS ] ).
ANALYSIS SUMMARY:

Tricompartmental Osteoarthritis Left Knee with Meniscal Tear / Degeneration 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.
Left Knee ROM
 (Degrees )
MEB ~ 7 Mo. Pre-Sep
 (200 80903 ) 		VA C&P ~ 2 Mo . Pre -Sep
 (200 90220 )
Flexion (140 Normal)
 130 105
Extension (0 Normal)
 0 0
Comment
 Tenderness
 No instability
 +Meniscus sign 		ROM equal R&L
Flexion limited by obesity
Gait normal
No instability
§4.71a Rating
 10% 10%

The CI sustained a left knee injury while playing football in 1998, one year prior to enter ing military service. At that time he underwent arthroscopic surgery to repair a left tor n meniscus. He recuperated well, entered service in May 1999 and continued uninterrupted military duties without any physical limitations. During his deployment to Iraq in 2005, the CI reinjured his knee while dismounting a HUMVEE vehicle. He noted “a sound of pop” of his left knee accompanied by swelling ( effusion ) . H e recovered from this injury bu t continued to experience pain una lleviated by non-surgical treatment. Magnetic resonance imaging (MRI) scan in June 2007 and evidenced a medial meniscus tear as well as degenerative joint disease and underwent arthroscopic surgery for meniscal repair in July 2007 . Post surgery he continued to have mechanical symptoms (locking and catching) of his left knee, and functional limitations . MRI exam ination August 2008 evidenced tricompartment al osteoarthritis of the left knee, degenerative changes of the medial meniscus and impingement of the anterior cruciate ligament without any meniscal or ligament tear. The CI noted increasing difficulty performing activities like bending, kneeling, jumping, running and carrying heavy loads and MEB was initiated. The MEB narrative summary ph ysical examination 3 September 2008 , eight months prior to separation , noted the left knee to be without deformities , inflammation or effusion . Range of motion was flexion 130 degrees and extension 0 degrees. There was tenderness and crepitus present however there were no “clicks or clunks . ” There was no ligament instability. McMurray test evidenced pain of the medial meniscus. There was no muscle atrop hy and strength was normal. The VA Compensation and Pension (C&P) exam from 20 February 2009, 2  months prior to separation noted report of sharp, burning pain around the knee cap occur ring “30 times/day” rated 6 out of 10 (ten being the maximum level of pain experienced) in intensity. The CI stated the pain was elicited by physical activity and was associated with stiffn ess, swelling and fatigability. He stated could do all activities of daily living ; however , climbing stairs and pushing a lawnmower were accompanied by pain. On p hysical examination the gait was normal without us e of assistive devices. Range motion of the right and left knees was equal with flexion of 105 degrees limited by obesity. Extension was 0 degrees bilaterally. There w as no evidence of instability, subluxation , locking pain, or effusion. Manipulation did not evidence any meniscal or ligament pathology. Repetitive movement was not associated with pain, weakness, lack of endurance, fatigue or incoordination .
The Board directs attention to its rating recommendation based on the above evidence. Both the PEB and VA rated the CI condition 10%, adjudicated under code 5003 (degenerative arthritis). A higher rating under this assigned code would require involvement of two or more major joints or two or more minor joints with occasional incapacitating exacerbations. The limitation of motion evidenced at the MEB and C&P examinations did not attain a minimum rating under the diagnostic codes for limitation of flexion or extension. There was no ligamentous injury or ligamentous instability, and there was no instability of the patellar joint after surgery to rate the left knee condition using the code for knee instability (5257). A rating of 10% could be supported with application of, §4.59 (painful motion) or §4.40 (functional impairment), or for symptomatic status post removal of semilunar cartilage 5258 (the CI underwent debridement but not complete removal). There was not a dislocated meniscus with frequent locking and effusion to assign ratings under code 5259. The Board found no evidence to support a rating higher than that adjudicated by the PEB. 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 acute t ricompartmental o steoarthritis l eft k nee with m eniscal t ear / d egeneration .


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. In the matter of the tricompartmental osteoarthriti s left knee with meniscal tear/ degeneration condition , 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
Tricompartmental Osteoarthritis Left Knee with Meniscal Tear/ Degeneration
 5003 10%
COMBINED
 10%


The following documentary evidence was considered:

Exhibit A. DD Form 294, dated 20121219, 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 AR20130010796 (PD201201982)

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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