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AF | PDBR | CY2013 | PD-2013-01379
Original file (PD-2013-01379.rtf) Auto-classification: Denied
RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME: XXXXXXXXXXXXXXXXX  CASE: PD-2013-01379
BRANCH OF SERVICE: Army  BOARD DATE: 20141120
SEPARATION DATE: 20040130


SUMMARY OF CASE: Data extracted from the available evidence of record reflects that this covered individual (CI) was an activated National Guard SPC/E-4 (91W/Medical Specialist) medically separated for chronic left knee pain. The 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 pain status post arthroscopy with degenerative joint disease (DJD),” was forwarded to the Physical Evaluation Board (PEB) IAW AR 40-501. Additionally, the “left hip degenerative joint disease and pain” was forwarded to the PEB as failing retention standards. The Informal PEB adjudicated “chronic left knee pain, status post arthroscopy with degenerative joint disease” as unfitting, rated at 10%, with application of the US Army Physical Disability Agency (USAPDA) pain policy. The left hip condition was determined to be not unfitting. The CI made no appeals and was medically separated.


CI CONTENTION: “I believe the severity of the conditions which resulted in the PEB discharge are more extensive/sever than originally rated. I am enclosing two letters from the US Office of Personnel Management which establish that the extent of the knee disability. One OPM Letter finds that the condition of my knees prevents me from continuing to work and the second OPM letter notifies me that I am being retired due to the condition of my knees. I feel that my PEB related disability is/was greater than 20%. Additionally, I am now rated as 10% service connected disabled by the VA due to hypertension. Again I believe the hypertension is more severe than rated at discharge from the Army.”


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 and not unfitting left hip conditions 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 20040109
 VA - (10 Mos. Post-Separation)
Condition
 Code Rating Condition Code Rating Exam
Left Knee Pain 5099-5003 10% Osteoarthritis s/p Torn Medial Meniscus Repair Left Knee 5259-5003 10% 20041103
Left Hip DJD and Pain Not Unfitting DJD Left Hip 5252-5003 10% 20041103
Other x 1 (In Scope)
 Other x 2
Combined: 10%
 Combined: 30%
Derived from VA Rating Decision (VA RD ) dated 20050210 ( most proximate to date of separation)

ANALYSIS SUMMARY:

Left Knee Condition. The narrative summary (NARSUM) notes the CI developed left knee pain with swelling, clicking and popping of the knee that was progressive despite conservative treatment. Left knee X-rays on 14 March 2003 showed DJD. Left knee magnetic resonance imaging on 28 March 2003 noted a large joint effusion with degenerative joint changes and questioned a medial meniscal tear. Diagnostic arthroscopy on 17 June 2003 diagnosed DJD without ligament or meniscal (semilunar cartilage) tears and a loose piece of articular cartilage were removed. The CI had three injections with synthetic joint fluid. The third injection on 16 September 2003 (approximately 5 months prior to separation) noted left knee pain level of 2/10 - 3/10, that increased with weight bearing, right knee had full range-of-motion (ROM), minimal joint swelling and sensation and strength were normal.

At the MEB examination on 14 November 2003 (approximately 3 months prior to separation), the CI reported occasional pain and swelling of the left knee. The MEB physical examiner noted a normal gait and ROMs were an extension-flexion of 0 to 125 degrees (0 to 140 degrees normal). There was a mild effusion of the left knee, without instability.

At the VA Compensation and Pension (C&P) examination on 3 November 2004 (approximately 9 months after separation), the CI reported knee pain that flared-up approximately 3 times per week that last 4-5 hours; noted joint swelling and locking at times. He reported wearing a soft left knee brace for activity and not missing work. The examiner noted the CI had a slow, stiff gait with normal posture. His left knee ROM was 0 to 100 degrees, crepitus with flexion/extension ROM, without evidence of instability or meniscal damage. Left knee X-ray images showed degenerative arthritic changes of the knee joint and patellofemoral joint, without effusion.

The Board directed attention to its rating recommendation based on the above evidence. The PEB rated the left knee condition at 10%, coded 5099-5003 (analogous to degenerative arthritis) and cited the USAPDA pain policy. The VA rated the left knee condition as 5259-5003 (semilunar cartilage removal, symptomatic with arthritis). The Board agreed that the evidence in the record of painful ROM of the left knee met 10% rating coded, either as 5003 for limited ROM with X-ray evidence of degenerative arthritis or as 5299-5260 for limited flexion that was painful, but did not meet the threshold for a compensable rating based on ROM alone. The Board reviewed the case for a clear path for a higher or additional rating of the left knee but there was no evidence of knee instability, compensable limited leg extension or semilunar cartilage injury/removal. Although the CI reported symptoms of the right knee, the right knee was not within the Board’s purview as elaborated in the Scope. Therefore, there was no support for a higher rating of 20% based upon 5003 rating criteria (X-ray evidence of two or more joints with occasional incapacitating exacerbations). 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 condition.

Contended PEB Conditions. The Board’s main charge is to assess the fairness of the PEB’s determination that the left hip condition was not unfitting. The Board’s threshold for countering fitness determinations is higher than the VASRD §4.3 (reasonable doubt) standard used for its rating recommendations, but remains adherent to the DoDI 6040.44 “fair and equitable” standard.

The CI reported left hip pain at a physical therapy visit on 30 July 2003 and examination noted painful hip ROM. At the MEB NARSUM examination (approximately 3 months prior to separation), the CI reported left hip pain. Left hip X-ray images noted early degenerative changes and ROM was flexion of 95 degrees (normal 125 degrees), with normal adduction and external rotation. At the VA C&P examination (approximately 9 months after separation), the CI reported left hip arthritis from favoring his left knee. He reported left hip pain approximately twice per week that lasts about an hour and limits him “a little bit,” and flare-ups every 2 months. ROM noted adduction of 20 degrees (normal 45 degrees) with otherwise full but painful motion. The left hip condition was not profiled or implicated in the commander’s statement and there was no performance based evidence from the record that the condition significantly interfered with satisfactory duty performance. After due deliberation in consideration of the preponderance of the evidence, the Board concluded that there was insufficient cause to recommend a change in the PEB fitness determination for the left hip condition and so no additional disability ratings are recommended.


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 condition 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 and IAW VASRD §4.71a, the Board unanimously recommends no change in the PEB adjudication. In the matter of the contended left hip condition, the Board unanimously recommends no change from the PEB determination as not unfitting. There were no other conditions within the Board’s scope of review for consideration.


RECOMMENDATION: The Board, therefore, recommends that there be no re-characterization of the CI’s disability and separation determination.


The following documentary evidence was considered:

Exhibit A. DD Form 294, dated 20130911, w/atchs
Exhibit B. Service Treatment Record
Exhibit C. Department of Veterans’ Affairs Treatment Record










                          
XXXXXXXXXXXXXXXXX
President
Physical Disability Board of Review


 SAMR-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 XXXXXXXXXXXXXXXXX , AR20150006430 (PD201301379)

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                                                  XXXXXXXXXXXXXXXXX
                                                      Deputy Assistant Secretary of the Army
                                                      (Review Boards)
                                                     
CF:
( ) DoD PDBR
( ) DVA

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