RECORD OF PROCEEDINGS

PHYSICAL DISABILITY BOARD OF REVIEW

NAME: XXXXXXXXXXXXX BRANCH OF SERVICE: Army

CASE NUMBER: PD1200266 SEPARATION DATE: 20061102

BOARD DATE: 20121005

SUMMARY OF CASE: Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty SPC/E-4 (21E10, Heavy Equipment Operator), medically separated for left knee traumatic arthritis. The condition was a consequence of a tire explosion in 2003 while deployed to Iraq. He did not respond adequately to operative and rehabilitative treatment and was unable to meet the physical requirements of his Military Occupational Specialty (MOS) or satisfy physical fitness standards. He was issued a permanent L3 profile and referred for a Medical Evaluation Board (MEB). The MEB forwarded left knee traumatic arthritis to the Physical Evaluation Board (PEB) as medically unacceptable IAW AR 40-501. No other conditions appeared on the MEB’s submission. The PEB adjudicated the left knee traumatic arthritis condition as unfitting, rated 0%, with application of the US Army Physical Disability Agency (USAPDA) pain policy. The CI made no appeals, and was medically separated with a 0% disability rating.

CI CONTENTION: “I was discharged from the Army due to the fact that I could not take the APFT because I could not run. The Army said I was medically unfit for service. I had joined the military because I wanted to be a helicopter pilot. I was injured in an explosion in Iraq in 2003 and was left with a shattered left knee and shoulder and minor head trauma. The military was my life and being told that it was over was bad enough but to give me a 0% disability rating was a slap in the face. I enlisted by choice and I deployed when they told me to and I was injured doing what the Army told me to and a thanks for service. I’m sorry but that’s not good enough and I am not the only one the Army did this to.”

SCOPE OF REVIEW: The Board wishes to clarify that the scope of its review as defined in the 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 left knee condition requested for consideration meets the criteria prescribed in DoDI 6040.44 for Board purview, and is accordingly addressed below. The shoulder and minor head trauma conditions are not within the Board’s purview. 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:

ANALYSIS SUMMARY:

Left Knee Condition. The traumatic event on 28 September 2003 resulted in an open left tibial plateau fracture that required percutaneous pinning. A lacerated quadriceps tendon and internal fixation of a femoral condyle fragment were performed on 4 October 2003. Significant intra-articular bone and cartilage loss required surgical revision, debridement and bone allograft was performed on 17 October 2003. Restricted knee motion due to intra-articular scar-like formation required arthroscopic intervention performed on 11 December 2003. Continued pain due to defects of the intra-articular cartilage was addressed with a final open surgery performed on 18 March 2004. There were two goniometric 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.

While deployed again to Iraq in 2005-2006, an orthopedist evaluated the CI (8 months prior to separation) for worsening knee pain. The CI reported a reduced ability to climb, squat or kneel due to increased activity and heavy gear requirements. Subsequent medical evacuation was required. At the MEB exam 4 months prior to separation, the CI reported constant left knee pain with associated popping snapping and swelling. The condition was aggravated by prolonged weight bearing and impact activities. Examination revealed mild swelling of the left knee with no tenderness. ROM testing noted limited flexion, but measurement was not specified. The commander’s statement 4 months prior to separation reported that mild to severe knee pain occurred during a long work day and prevented him from doing his job to the best of his ability. The narrative summary (NARSUM) 3 months prior to separation noted a chief complaint of knee pain. Occasional popping, grinding and effusion were also reported. Locking and instability symptoms were absent. Despite considerable resolution of pain with therapeutic knee injections, the CI was still unable to run, ruckmarch or perform basic soldiering tasks due to discomfort. Examination revealed tenderness of the medial and lateral joint line. There was no evidence of knee instability. Muscle strength testing was normal.
X-rays revealed degenerative and post-operative changes. Magnetic resonance imaging (MRI) revealed healed tibial plateau and lateral femoral condyle fractures, thinning and irregularity of the lateral femoral articular cartilage, patellar chondromalacia and extensive synovitis. At the VA Compensation and Pension (C&P) exam 5 months after separation, the CI reported that the knee condition caused no problems with occupational functioning as a heavy equipment operator, but moderately interfered with sports participation. Episodes of locking, giving way and instability were denied, but stiffness and pain were reported. Examination revealed a normal gait. Pain during ROM testing was not present, but the tibial donor site used for a surgical repair was protruding and painful during kneeling. X-rays revealed patellofemoral osteophytes.

The Board directs attention to its rating recommendation based on the above evidence. The PEB assigned a 0% rating under the Veteran’s Administration Schedule for Rating Disabilities (VASRD) 5010 code (traumatic arthritis) with likely application of the USAPDA pain policy. The VA used an analogous Group XIV muscle VASRD code (5399-5314) and assigned a 10% rating based on an assessment that the severity of the thigh muscle disability was “moderate.” The Board considered that sufficient evidence is present to support a 10% rating under §4.40 (pain with use/functional loss), or under the VASRD 5259 code (“Cartilage, semilunar, removal of, symptomatic”). Board members agreed there was no pathway to a higher rating under VASRD codes 5257, 5258, 5260, 5261, 5262 or 5314 codes. 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.

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 traumatic left knee arthritis was operant in this case and the condition was adjudicated independently of that policy by the Board. In the matter of the traumatic left knee arthritis 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:

The following documentary evidence was considered:

Exhibit A. DD Form 294, dated 20120229, w/atchs

Exhibit B. Service Treatment Record

Exhibit C. Department of Veterans’ Affairs Treatment Record

XXXXXXXXXXXXXXXXXXX

President

Physical Disability Board of Review

SFMR-RB

MEMORANDUM FOR Commander, US Army Physical Disability Agency

(TAPD-ZB / ), 2900 Crystal Drive, Suite 300, Arlington, VA 22202-3557

SUBJECT: Department of Defense Physical Disability Board of Review Recommendation

for XXXXXXXXXXXXX, AR20120018608 (PD201200266)

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 XXXXXXXXXXXXXXX

Deputy Assistant Secretary

(Army Review Boards)

CF:

( ) DoD PDBR

( ) DVA