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AF | PDBR | CY2013 | PD-2013-02156
Original file (PD-2013-02156.rtf) Auto-classification: Approved
RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME: XXXXXXXXXXXXXXX    CASE: PD-2013-02156
BRANCH OF SERVICE: Army  BOARD DATE: 20140829
SEPARATION DATE: 20031201


SUMMARY OF CASE: Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty SPC/E-4 (92M/Mortuary Affairs Specialist) medically separated for a left knee condition; which could not be adequately rehabilitated to meet the physical requirements of her Military Occupational Specialty or satisfy physical fitness standards. She was issued a permanent L3 profile and referred for a Medical Evaluation Board (MEB). The left knee condition, characterized as “chronic left knee pain with retropatellar pain syndrome [RPPS]” was forwarded to the Physical Evaluation Board (PEB) IAW AR 40-501. The PEB adjudicated “chronic left knee pain” as unfitting, rated 0%, referencing the US Army Physical Disability Agency (USAPDA) pain policy. The CI made no appeals and was medically separated.


CI CONTENTION: “In 2002 I received a 0% rating for my reactive airway disease [RAD] but in 2013 it was found service-connected and given a 30% rating. I also only received 10% for each knee but had 2 surgeries on my left knee.”


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. The referenced right knee and respiratory conditions were not identified by the PEB, and thus are not within the DoDI 6040.44 defined purview of the Board. Those, and any conditions or contention not requested in this application, remain eligible for future consideration by the Board for Correction of Military Records.


 RATING COMPARISON :

Service IPEB – Dated 20031020
 VA*
Condition
 Code Rating Condition Code Rating Exam
Chronic Left Knee Pain 5099-5003 0% Residuals Left Knee Arthroscopy w/ RPPS * 10% *
Other X 0 (Not in Scope)
 Other VA Ratings: RAD 30%; R Knee 10%; L Wrist 0%
Combined: 0%
 Combined: 50%

No VA rating decisions n or the Compensation and Pension (C& P) evaluations were in evidence. Above conditions (without codes ) and ratings derived from a VA “streamlined notice” in lieu of “information previously contained in a separate rating decision”, which is dated 20120813 and documents receipt of the claim on 20120521.


ANALYSIS SUMMARY: The Board notes the earliest VA evaluation was over 8 years after the date of separation. DoDI 6040.44 provides for consideration of post-separation VA findings, particularly within 12 months of separation, although the Board’s recommendation is premised on the degree of disability at separation. Therefore evidence from the record was assigned the determinant probative value with respect to the Board’s recommendations.
Left Knee Condition. The earliest entry in the service treatment record (STR) regarding the condition is from October 2000 and notes an onset of left knee pain 3 weeks earlier without trauma. The pain persisted and there are fairly frequent STR entries addressing the condition after the initial visit (one noting onset with “stepping to make a turn”). Magnetic resonance imaging was obtained in October 2001 and, although there were no confirmatory findings, meniscal (cartilage) injury was suspected. The CI underwent arthroscopic intervention in December 2001 and a small degenerative defect of the lateral meniscus was identified and debrided. The joint was otherwise healthy, and ligaments were uninvolved. She continued to complain of post-operative pain (worse than pre-surgery by her account) and the STR documents a protracted course of physical therapy (PT), analgesics and activity modification (L2 profile) over the ensuing period leading up to MEB proceedings. A PT note obtained 5 weeks after surgery documented flexion to 110 degrees (normal 140 degrees; minimum compensable 45 degrees) and numerous STR entries document recovery to grossly normal range-of-motion (ROM) after that. The CI sought a second opinion from a civilian orthopedist in April 2002, who documented normal ROM (albeit with pain, “quite dramatic in her protestation”) and ligamentous stability and, the examiner concurred with the diagnosis of RPPS. The last detailed orthopedic examination in the STR prior to the narrative summary (NARSUM) is from May 2003 (8 months prior to separation) and, documents medial tenderness (no mention of effusion), flexion to 120 degrees, no signs of cartilage impingement and no ligamentous laxity to stress maneuvers in all planes. There are no STR entries documenting significant ROM limitation, effusion, locking or instability.

The NARSUM (by an orthopedist) attributes the condition to a twisting mechanism while negotiating an obstacle course in 2000; and, notes continued “painful popping clicking in her left knee ... unable to run or ruck” with “some painful mechanical symptoms, although there are no instability symptoms.” The physical exam did not comment on effusion or tenderness, recorded flexion to 135 degrees and provided detailed findings demonstrating ligamentous stability and negative for cartilage impingement. As noted above, there is no significantly probative VA or other post-separation evidence.

The Board directed attention to its rating recommendation based on the above evidence. The PEB’s 0% rating analogous to 5003 (degenerative arthritis) was supported by the USAPDA pain policy; but, skirts application of VASRD §4.59 (painful motion) or §4.40 (functional loss) and, does not defer to §4.7 (higher of two evaluations) with regards to more favorably rated joint codes (applicable in this case as follows). The evidence confirms that there was no significant ROM impairment, instability, frequent effusions or locking in this case which would provide for a rating higher than 10% (via §4.59 or §4.40) under 5003 or any joint code available under VASRD §4.71a; but, code 5259 (cartilage, semilunar, removal of, symptomatic) is applicable to this case and provides for a 10% rating independent of any other criterion. After due deliberation, considering all of the evidence and conceding VASRD §4.3 (reasonable doubt), the Board recommends a 10% rating for the left knee condition under code 5259.


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 rating was operant in this case and the knee condition was adjudicated independently of that policy by the Board. In the matter of the left knee condition, the Board unanimously recommends a disability rating of 10%, coded 5259, 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 her prior medical separation:

UNFITTING CONDITION VASRD CODE RATING
Residuals of Meniscectomy, Left Knee 5259 10%
RATING 10%


The following documentary evidence was considered:

Exhibit A. DD Form 294, dated 20131101, w/atchs
Exhibit B. Service Treatment Record
Exhibit C. Department of Veterans’ Affairs Treatment Record







                 
XXXXXXXXXXXXXXX
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, AR20150007133 (PD201302156)


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 of the Army
                           (Review Boards)

CF:
( ) DoD PDBR
( ) DVA

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