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AF | PDBR | CY2013 | PD-2013-01429
Original file (PD-2013-01429.rtf) Auto-classification: Denied
RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME: XXXXXXXXXXXXXXXXX  CASE: PD-2013-01429
BRANCH OF SERVICE: Army  BOARD DATE: 20140829
SEPARATION DATE: 20040325


SUMMARY OF CASE: The available evidence of record reflects that this covered individual (CI) was an activated Reserve SPC/E-4 (95B/Military Police) medically separated for a left knee condition. The condition could not be adequately rehabilitated to meet the requirements of her Military Occupational Specialty. She was issued a permanent L3 profile and referred for a Medical Evaluation Board (MEB). The knee condition, characterized as “ left knee degenerative joint disease (DJD), ” was forwarded to the Physical Evaluation Board (PEB) IAW AR 40-501. No other conditions were submitted by the MEB. The Informal PEB adjudicated chronic pain, left knee as unfitting, rated at 10%, cited application of the US Army Physical Disability Agency (USAPDA) pain policy. The CI made no appeals and was medically separated.


CI CONTENTION: “Knees have gotten worse. Shots ever [sic] 6 months. More limitations.”


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.

The Board acknowledges the CI’s information regarding the significant impairment with which her service-connected condition continues to burden her; but, must emphasize that the Disability Evaluation System has neither the role nor the authority to compensate members for anticipated future severity or potential complications of conditions resulting in medical separation. That role and authority is granted by Congress to the Department of Veterans Affairs, operating under a different set of laws.


RATING COMPARISON :

Service IPEB – Dated 20040310
 VA* - (~2.5 Mos. Post-Separation)
Condition
 Code Rating Condition Code Rating Exam
Chronic Pain, Left Knee… 5099 - 5003 10% Left Knee DJD 5003 10% 20040609
Other x 0 (Not in Scope)
 Other x 1 (Not in Scope) 20040609
Rating: 10%
 Rating: 10%
Derived from VA Rating Decision (VA RD ) dated 200 41104


ANALYSIS SUMMARY:

Left Knee Condition. The service treatment record indicated that the CI had chronic left knee pain since basic training around April or May 2000 and was diagnosed with patellar tendonitis. Thereafter she was evaluated by both orthopedics and sports medicine. She was initially managed with physical therapy and received a corticosteroid injection into the left knee. Subsequently, while in an inactive duty status, she underwent an arthroscopic left knee three compartment synovectomy (to remove inflamed joint membrane tissue) for post-traumatic synovitis (inflammation of the joint membrane) with symptomatic synovial plica syndrome (congenital band(s) below the knee cap) in February 2001. She again had arthroscopic surgical debridement in October 2002 with the diagnosis of DJD and a prior history of a meniscal tear. An L3 profile was issued for left knee pain on 13 March 2003. She also received Hyalgan injections for osteoarthritis in November 2003, without significant improvement as well as with nonsteroidal anti-inflammatory medication. An orthopedic appointment on 13 November 2003 (obtained 4 months prior to separation), noted full range-of-motion (ROM), intact ligaments and negative signs of meniscal irritation. A permanent L3 physical profile was issued on 18 November 2003, for left knee DJD with restrictions of no running, jumping, marching, climbing, pushing, pulling or carrying more than 40 pounds.

At the MEB examination dated 26 November 2003 the CI reported wearing neoprene knee supports bilaterally. The MEB examiner noted mild pain on flexion and extension of both knees with mild patellar crepitus (audible or palpable crackling of the knee) without an effusion (fluid in or around the knee joint) or joint instability. No comment on motion, stability or gait was made. The MEB narrative summary dated 10 December 2003 indicated the CI complained of left knee pain worse during cold weather status post arthroscopic surgery two times without any resolution of the pain. She reported exacerbations since after deployment in 2003. Her daily activities and function were limited by the pain and she was unable to lift any heavy weights thereby impacting her job. The examiner also noted the findings of a knee examination that was performed in February 2003. The knee was stable. The ROM measurements are in the chart below. No comment was made on meniscal irritation or gait.

At the VA Compensation and Pension examination dated 17 June 2004, performed 2.5 months after separation, the CI reported her left knee pain began during basic training without trauma and she underwent arthroscopic debridement in 2001 and 2002. Left knee pain was achy in nature and sharp at times, and she rated it 5/10 (10 being the worst pain). She also noted the knee could lock, pop and be stiff. Treatment consisted of nonsteroidal anti-inflammatory medication. She indicated experiencing a flare-up of left knee pain, which would last for about 24 hours, every 1 to 2 months if she ran, mowed the grass or rode horse back. She wore a neoprene brace on the left knee at times. Post-separation, she returned to her work as a Pepsi route manager, which required heavy lifting and pulling of heavy pallets but was unable to do her job. The goniometric 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)
Ortho ~ 4 Mo. Pre-Sep MEB ~ 4 Mo. Pre-Sep MEB NARSUM ~ 2.5 Mo. Pre-Sep VA C&P ~ 2.5 Mo. Post-Sep
Flexion (140 Normal)
full” -- 130 135
Extension (0 Normal)
full” -- +5 0
Comment
 P alpable crepitus
with ROM, knee ligaments intact		 Mild pain on f lexion and extension no effusion or joint instability Stable knee Pain at the extreme of flexion, Normal gait.
§4.71a Rating
 0% (PEB 10%) -- 0% 10% (VA 10%)

The Board directed attention to its rating recommendation based on the above evidence. The PEB assigned a 10% rating using an analogous code for degenerative arthritis, 5099-5003, for chronic left knee pain rated as slight/constant IAW USAPDA pain policy. The VA awarded a rating of 10% for left knee DJD using code 5003 (arthritis, degenerative hypertrophic or osteoarthritis). The limitation of motion supported a 10% rating. Absent subluxation, instability or evidence of meniscal pathology, the Board found no route for a higher rating than the 10% 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 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 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. 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


 S AMR-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 , AR20150006340 (PD201301429)

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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