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AF | PDBR | CY2013 | PD-2013-01904
Original file (PD-2013-01904.rtf) Auto-classification: Approved
RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME: XXXXXXXXXXXXXXXXXXXX      CASE: PD-2013-01904
BRANCH OF SERVICE: Army          BOARD DATE: 20150730
SEPARATION DATE: 20040915


SUMMARY OF CASE: Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E-3 (Optical Lab Specialist) medically separated for a right knee condition. 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). Right knee chronic patellar tendonitis, anterior cruciate ligament [ACL] deficiency s/p reconstruction and medial meniscal tear were forwarded to the Physical Evaluation Board (PEB) IAW AR 40-501. No other condition was submitted by the MEB. The Informal PEB adjudicated right knee pain as unfitting, rated 0% with likely application of the AR 635-40. The CI made no appeals and was medically separated.


CI CONTENTION: His condition continues to worsen. His complete submission is at Exhibit A.


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 when specifically requested by the CI, those conditions identified by the PEB, but determined to be not unfitting. Any conditions outside the Board’s defined scope of review and any contention not requested in this application may remain eligible for future consideration by the Board for Correction of Military Records. Furthermore, the Board’s authority is limited to assessing the fairness and accuracy of PEB rating determinations and recommending corrections, where appropriate. The Board’s assessment of the PEB rating determinations is confined to review of medical records and all available evidence for application of Veterans Affairs Schedule for Rating Disabilities (VASRD) standards to the unfitting medical condition at the time of separation. The Board has neither the role nor the authority to compensate for post-separation progression or complications of service-connected conditions. That role and authority is granted by Congress to the Department of Veterans Affairs, operating under a different set of laws. The Board gives consideration to VA evidence, particularly within 12 months of separation, but only to the extent that it reasonably reflects the severity of the disability at the time of separation.


 RATING COMPARISON :

IPEB – Dated 20040721
 VA* - (Based on Service Treatment Records [STR])
Condition
 Code Rating Condition Code Rating Exam
Right Knee Pain 5099-5010 0% S/P ACL Reconstruction, R Knee 5257 0% STR
Other MEB/PEB Conditions x 0 (Not In Scope)
 Other x 0
RATING: 0%
 RATING: 0%
* Derived from VA Rating Decision (VA RD ) dated 200 51013 (most proximate to date of separation [ DOS ] )



ANALYSIS SUMMARY:

Right Knee Pain. The MEB narrative summary (NARSUM) detailed that the CI suffered a twisting injury to the right knee in October 2002 (2 years prior to separation). He heard and felt a pop, and had an immediate effusion with inability to ambulate. He was initially treated with physical therapy, and had persistent episodes of locking and effusions. In March 2003 he was evaluated in orthopedics, and was diagnosed with an ACL deficiency and a medial meniscal tear. In April 2003 (17 months prior to separation) he underwent ACL reconstruction, and the menisci were found to be intact. He did well with rehabilitation for 3 months but in July 2003 he had a sudden pop and pain at the inferior pole of his patella (kneecap) while stepping on a stair. He was initially treated with a brace, but continued to have pain with increased levels of activity. Magnetic resonance imaging on 23 February 2004 showed the prior ACL reconstruction with a thin, intact ligament, but did not mention any arthritis. He had a second surgery (arthroscopic debridement of the patellar tendon) on/about 1 April 2004 (5 months prior to separation) but despite adequate rehabilitation he had persistent pain and limping. His pain was aggravated with his regular duties in the optical lab and he was referred to the MEB.

The CI was seen in orthopedic clinic on 3 May 2004, 29 days after surgery. He stated that he still had tenderness on the inferior pole of the patella, and that his pain was no better than before surgery. On examination, the examiner said, “Still has some tenderness to palpation in the area; wound is well healed; neurovascularly intact distally;” range-of-motion (ROM) 0-130 degrees (normal 0 to 140).” A DA Form 3349, Physical Profile, was generated and had many duty/activity restrictions including limitations on running, walking, biking, swimming, lifting, and standing. A DD Form 2808, Report of Medical Examination, was accomplished on 18 June 2004 (3 months prior to separation), and the CI had knee pain with decreased extension and strength. The surgical scar was mentioned but not described. The MEB NARSUM examination was accomplished on 6 July 2004 (2 months prior to separation) and showed well-healed incisions, tenderness to palpation at the inferior pole of the patella, no effusion, ROM from 0 to 135 degrees, intact neurovascular exam, and no evidence of instability.

A VA Compensation & Pension (C&P) examination was not performed until 9 December 2009, more than 5 years post-separation, which was too remote from the date of separation to have probative value for this disability rating determination.

The Board directed its attention to its rating recommendation based on the above evidence. The PEB rated the condition at 0% under analogous code 5010 (Arthritis due to trauma), citing pain, full ROM, and no ligamentous laxity. The PEB supported the application of this analogous code “as there is tendon degeneration which from a rating point of view is closest to degenerative arthritis.” The VA assigned a noncompensable (0%) rating because they were unable to determine the CI’s current level of disability (there was no C&P exam). The Board noted that the three conditions forwarded by the MEB all dealt with the anatomy and the disability of the knee, and that members needed to avoid §4.14, avoidance of pyramiding (evaluation of the same disability under various diagnoses). There was no compensable ROM impairment and no evidence of the presence of ligamentous laxity, frequent effusions, or locking (or any indication of loose body); therefore, a dual rating was not supported. All three examinations identified above documented a small, but consistent, decrease in ROM of the knee joint. The MEB NARSUM detailed that the CI had pain and a limp at the end of the day with routine activities (indicative of painful motion), although none of the three examinations described direct observation of painful motion as defined under code 5003 (degenerative arthritis). The pain and limp reflected potential functional loss, as did the profile restrictions and the decreased strength noted in the DD Form 2808 exam. Members agreed that §4.59 (painful motion) was supported by the evidence to achieve a rating of 10% under code 5003 or 5010. 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 right knee pain 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 likely reliance on the AR 635-40 for rating the right knee condition was operant in this case and the condition was adjudicated independently of that regulation by this Board. In the matter of the right knee pain condition, the Board unanimously recommends a disability rating of 10%, coded 5099-5010 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:

CONDITION
 VASRD CODE RATING
Right Knee Pain 5099-5010 10%


The following documentary evidence was considered:

Exhibit A. DD Form 294, dated 20130906, w/atchs
Exhibit B. Service Treatment Record
Exhibit C. Department of Veterans Affairs Treatment Record









XXXXXXXXXXXXXXX
President
DoD 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 XXXXXXXXXXXXXXXXXXXX , AR20150015572 (PD201301904)
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                                                  XXXXXXXXXXXXXXXXXXXX
                                                      Deputy Assistant Secretary of the Army
                                                      (Review Boards)

CF:
( ) DoD PDBR
( ) DVA

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