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AF | PDBR | CY2013 | PD-2013-02216
Original file (PD-2013-02216.rtf) Auto-classification: Approved
RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME: XXXXXXXXXXXXXXX    CASE: PD-2013-02216
BRANCH OF SERVICE: Army         BOARD DATE: 20150217
SEPARATION DATE: 20040502


SUMMARY OF CASE: Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty PFC/E-3 (91W/Health Care Specialist) medically separated for 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 condition characterized as “left posterior medial meniscus tear, pain is minimal and constant” was the only condition forwarded to the Physical Evaluation Board (PEB) IAW AR 40-501. The Informal PEB adjudicated “chronic pain left knee, due to posterior medial meniscus tear” as unfitting, rated 0%, c iting a pplication of the US Army Physical Disability Agency (USAPDA) pain policy. The CI made no appeals and was medically separated.


CI CONTENTION: “Multiple: Left knee condition and chronic hearing loss. I was last treated at Ellcim Family Practice. I also request to be considered for SC for epididymitis. I was “first” diagnosed 01/02 (Feb) 2002.”


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/Naval 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 the 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 20040312
 VA* - Based on Service Treatment Records (STR)
Condition
 Code Rating Condition Code Rating Exam
Chronic Pain Left Knee, Due to Posterior MMT 5099-5003 0% MMT, Left Knee 5237 10% STR
Other x 0 (Not In Scope)
 Other x 2
RATING: 0%
 RATING: 10%
* Derived from VA Rating Decision (VA RD ) dated 200 41029 (most proximate to date of separation ( DOS ) ) .


ANALYSIS SUMMARY:

Chronic Pain Left Knee, Due to Posterior Medial Meniscus Tear Condition. The first record in evidence was a primary care note dated 23 June 2003 in which the CI reported a 2-year history of left knee pain. X-rays that day were normal. He was given duty limitations and referred to physical therapy (PT). There he reported an initial twisting injury 2 years previously, but a recent increase in running had aggravated his pain. On examination, the range-of-motion (ROM) was normal and the knee stable, but signs of meniscal irritation present. Despite PT, his pain persisted and he was evaluated in orthopedics on 22 August 2003. There the ROM was limited with flexion of 110 degrees (140 normal) and signs of a medial meniscus tear (MMT) were present. Five days later in PT his ROM was improved to 135 degrees. A magnetic resonance imaging on 3 September 2003 confirmed the clinical diagnosis of a left MMT. The CI was again seen in orthopedics on 16 September 2003 and declined surgery. At the MEB examination on 6 October 2003, 7 months prior to separation, the CI reported constant pain. The examiner noted joint line pain, pain with meniscal irritation, and full ROM. The narrative summary was performed on 16 January 2004, less than 4 months prior to separation. The CI reported that the pain was present 100% of the time, but that he took no medications. It occasionally interfered with sleep. The examiner referred back to the MEB DD Form 2808 performed in October, but also noted that there was no instability or effusion. No VA Compensation and Pension examination was performed proximate to separation. The 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 ~9 Mo. Pre-Sep PT ~8 Mo. Pre-Sep MEB ~ 4 Mo. Pre-Sep
Flexion (140 Normal) 110 135 FROM
Extension (0 Normal) 0 5 FROM
Comment Signs of a MMT Nml gait No comment on gait or pain with motion
§4.71a Rating 0 % 0 % 0 %

The Board directed its attention to its rating recommendation based on the above evidence. The PEB rated the left knee at 0% using an analogous code 5099-5003 (degenerative arthritis) and citing the pain policy. The VA, relying on the STRs, rated the knee at 10% using the code 5257, other impairment of the knee with recurrent subluxation or lateral instability. These were not present. The Board noted that the meniscal code 5258 requires frequent locking and an effusion, neither of which were present. The meniscal code 5259 is used after surgical removal of all or part of the meniscus. No surgery was accomplished. Extension and flexion were both limited on different examinations, but not consistently nor to a compensable level on any examination. The Board did note though that the CI was referred to the MEB due to pain with activity which satisfies the requirement for painful motion referencing of VASRD §4.59. This supports a 10% rating for the knee for painful motion using the PEB code 5099-5003. 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 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 pain was operant in this case and the condition was adjudicated independently of that policy by this Board. In the matter of the left knee condition, the Board unanimously recommends a disability rating of 10%, coded 5099-5003 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
Chronic Pain Left Knee, Due to Posterior MMT 5099-5003 10%
COMBINED 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
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 XXXXXXXXXXXXXXX, AR20150010415 (PD201302216)


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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