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AF | PDBR | CY2013 | PD-2013-01797
Original file (PD-2013-01797.rtf) Auto-classification: Denied
RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME: XXXXXXXXXXXXXXXXXX         CASE: PD-2013-01797
BRANCH OF SERVICE: Army  BOARD DATE: 20140430
SEPARATION DATE: 20050602


SUMMARY OF CASE: The available evidence of record indicates this covered individual (CI) was an activated Reserve SGT/E-5 (74D/Chemical, Biological, Radiological and Nuclear Specialist) medically separated for a right knee condition. This condition was considered to be non-surgical and could not be adequately rehabilitated to meet the requirements of his Military Occupational Specialty or physical fitness standards, so he was issued a permanent L3 profile and referred for a Medical Evaluation Board (MEB). The right knee condition, characterized as “patellofemoral syndrome, right,” was forwarded to the Physical Evaluation Board (PEB) IAW AR 40-501. No other conditions were submitted by the MEB. The PEB adjudicated “chronic right knee pain, secondary to patellofemoral syndrome” as unfitting, rated 10% IAW the US Army Physical Disability Agency (USAPDA) pain policy. The CI made no appeals and was medically separated.


CI CONTENTION: “I was never rated for PTSD, Bilateral Hearing Loss, & Tinnitus. Since the time of my discharge these disabilities have been diagnosed as service connected through the Department of Veterans Affairs.”


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 right knee condition is addressed below; no additional conditions are within the DoDI 6040.44 defined purview of the Board. The contended conditions of posttraumatic stress disorder, hearing loss and tinnitus were not identified by the PEB so are not in the purview of this 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 his service-connected conditions burden him, but must emphasize that the Disability Evaluation System has neither the role nor the authority to compensate members for any conditions other than those that cause medical separation (conditions deemed unfitting). The role and authority to compensate for service-connected conditions that do not result in separation is granted by Congress to the Department of Veterans Affairs (DVA), which operates under a different set of laws. The Board considers the DVA evidence proximate to separation in arriving at its recommendations, and DoDI 6040.44 defines a 12-month interval for special consideration to post-separation evidence. Post-separation evidence is probative to the Board’s recommendations only to the extent that it reasonably reflects disability (of unfitting conditions) at the time of separation. The Board emphasizes that disability compensation may only be offered for those conditions that cut short the member’s career.


RATING COMPARISON :

Service PEB – Dated 20050511
 VA - (4 Yrs. Pre/Post-Separation)
Condition
 Code Rating Condition Code Rating Exam
Chronic Right Knee Pain… 5099-5003 10% Medial Meniscal Tear…R Knee 5261-5260 10% 20090324
No Additional MEB/PEB Entries
 Other x 0
Combined: 10%
 Combined: 10%
Derived from VA Rating Decision (VA RD ) dated 200 90520 .


ANALYSIS SUMMARY:

Right Knee Pain Condition . The goniometric range-of-motion (ROM) evaluations in evidence the Board weighed in arriving at its rating recommendation, with documentation of additional ratable criteria, are summarized in the chart below.

Right Knee ROM
(Degrees)		 Ortho ~2 Mo. Pre-Sep
(20050316)
 MEB ~2 Mo. Pre-Sep
(2005032 3 )
Flexion (140 Normal) 132 130
Extension (0 Normal) 0 0
Comment +McMurray
No instability		 Pain and crepitus with squatting
§4.71a Rating 10 % 10%

Service treatment records show that the CI complained of intermittent pain since initially injuring his right knee in January 2002 during unit physical training . His knee was further aggravated by rough terrain and wearing combat gear while deployed to Afghanistan . On 21   July 2003 , a right knee magnetic resonance imaging ( MRI ) showed a possible oblique tear at the posterior horn of the medial meniscus . At a 25 July 2003 orthopedic evaluation, the CI complained of primarily pain in the anterior right knee , worse with running and knee loading activities . Physical examination of the knee revealed tenderness to palpation, compression and gliding . The right knee was ligamentously stable and showed full ROM . There was no erythema, warmth or effusion to the knee . The surgeon reviewed the MRI and recommended non-surgical treatment and administered a corticosteroid injection into the knee. At the time of follow - up with the orthopedic surgeon on 8 August 2003, the CI reported minimal pain with only slight pain with excessive rotational torque to the knee . On examination, the knee demonstrated no edema, warmth or effusion . The knee demonstrated full ROM , ligamentous stability and no tenderness to palpation . There was mild pain on testing for meniscus pathology ( modified McMurray’s test ). Due to recurring pain, a repeat MRI of the right knee was performed on 3 February 2005 which showed degeneration with an equivocal tear of the posterior horn of the medial meniscus, not dramatically changed since 21 July 2003 . At the time of a 3 March 2005 physical therapy examination, the CI reported intermittent right knee pain and inability to run due to pain. On examination the right knee active ROM was “within normal limits” and gait was normal. There was no instability but the McMurray’s test was positive for meniscus symptoms. At a 1 6 March 2005 orthopedic surgery appointment , the CI complained of intermittent anteromedial and retropatellar right knee pain aggravated by increased activity or prolonged sitting . Pain was associated with occasional popping, giving out and swelling . Examination of the right knee showed slight anteromedial and peripatellar tenderness to palpation . The right knee demonstrated normal strength and full ROM (0-0-132 degrees) without tenderness, swelling, erythema, warmth, deformity or ligamentous laxity . Dynamic testing showed McMurray’s test was positive, but not painful and patellar grind test (for patellofemoral pain syndrome) was positive . Apley’s test, anterior/posterior drawer test and Lachman’s test were negative for instability or laxity. The orthopedic surgeon reviewed the MRI and concluded that i maging and examination findings were consistent with patellofemoral syndrome and asymptomatic medial meniscus posterior horn tear , which were considered nonsurgical . The 23 March 2005 MEB physica l examination (DD Form 2808) reported a normal right knee ROM , recorded in the chart , which was equal to the asymptomatic left knee. There was no knee laxity and leg strength was normal. Per the 29 March 2005 MEB n arrative s ummary (NARSUM), the CI reported exacerbation of right knee pain and swelling with impact and repetitive activities . The MEB NARSUM cited the examination from 23 March 2005. The first VA C ompensation and P ension (C&P) examination was on 24 March 2009, nearly 4 years after separation . It documented normal gait, normal right knee ROM and no knee locking or instability.

The Board directs attention to its rating recommendation based on the above evidence . The PEB rated the right knee condition 10% (coded 5099-5003) with application of the USAPDA pain policy. The VA C&P examination was nearly 4 years after separation and was not considered to have any probative weight due to its lack of proximity to the time of separation . The right knee ROM reported at the MEB examination and in the service treatment records in the months prior to separation , consistently documented near normal ROM . There was no limitation of motion that supported a minimum rating u nder the VASRD diagnostic code 5260 ( limitation of flexion ) or code 5261 (limitation of extension) . Although there was evidence of a torn meni scus, it was not dislocated or associated with episodes of locking and therefore did not support a rating under the diagnostic code 5258 (dislocated meniscus with frequent episodes of locking pain and effusion into the joint). There was no instability to support a rating under the diagnostic code 5257 (recurrent subluxation or instability). Board members agreed that there was sufficient evidence of pain with use prior to separation, as well objective examination and imaging findings to support a 10% rating with application of painful motion ( § 4.59) and functional loss ( § 4.40). 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 right 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 right knee pain condition was operant in this case and the condition was adjudicated independently of that policy by the Board. In the matter of the right knee pain 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 no recharacterization of the disability and separation determination.
The following documentary evidence was considered:

Exhibit A. DD Form 294, dated 20131022, w/atchs
Exhibit B. Service Treatment Record
Exhibit C. Department of Veterans’ Affairs Treatment Record








                                   
XXXXXXXXXXXXXXXXXX
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 XXXXXXXXXXXXXXX, AR20150000992 (PD201301797)

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

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