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AF | PDBR | CY2013 | PD-2013-02422
Original file (PD-2013-02422.rtf) Auto-classification: Approved
RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME: XXXXXXXXXXXXXXXXX  CASE: PD-2013-02422
BRANCH OF SERVICE: Army  BOARD DATE: 20141022
SEPARATION DATE: 20060627


SUMMARY OF CASE: Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty SGT/E-5 (92A/Automated Logistical Specialist) medically separated for left knee condition. The condition 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 “advanced osteoarthritis of the left knee” was forwarded to the Physical Evaluation Board (PEB) IAW AR 40-501. The MEB also identified and forwarded four other conditions as not disqualifying: major depressive disorder, dyslipidemia, bilateral carpal tunnel syndrome and migraine headaches (well controlled) for PEB adjudication. The Informal PEB adjudicated “chronic left knee pain secondary to osteoarthritis” as unfitting, rated 0%. The remaining conditions were determined to be not unfitting. The CI made no appeals and was medically separated.


CI CONTENTION: “I have arthritis in (L) knee which has gotten, progressively worse over the years. I have difficulty climbing stairs, squatting, bending as the pain is sometimes unbearable Because of my arthritis, my (L) knee stays constantly swollen & I have pain and discomfort (word not legible) while sitting for extended periods of times. I received a 0% rating after 15 years in the Army and my condition has worsened.”


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; no additional conditions are within the DoDI 6040.44 defined purview of the Board. 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. 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 Corrections of Military Records.


RATING COMPARISON :

Service IPEB – Dated 20060530
 VA - (4 Mos. Post-Separation)
Condition
 Code Rating Condition Code Rating Exam
Chronic Left Knee Pain Secondary to Osteoarthritis 5003 0% Bilateral Feet Bunions with Hallux Valgus and DJD and Bilateral Knee Osteoarthritis 5299-5010 10% 20061011
Other x 4 (Not in Scope)
 Other x 4
Combined: 0%
 Combined: 50%
Derived from VA Rating Decision (VA RD ) dated 200 70827 ( most proximate to date of separation [ DOS ] ).


ANALYSIS SUMMARY:

Chronic Left Knee Pain Secondary to Osteoarthritis Condition. The narrative summary (NARSUM) and record noted two left knee arthroscopic surgeries prior to Service entry (1987 and 1988 per MEPs exam). There was no waiver required for entry and the CI had an in-service left knee injury in 1993 with an anterior cruciate ligament repair in 1994. Symptoms progressed and in November 2005 she was placed on profile. At the MEB exam, the CI reported left knee pain with fairly constant mild swelling. She reported “some ‘give way’ symptoms approximately five to six times per week” and “some catching but no true locking.” The MEB physical exam (DD Form 2808 dated 18 November 2005; 7 months prior to separation) documented left knee mild diffuse swelling with multiple scars. Active range-of-motion (ROM) was “extension good” and flexion limited to 90 degrees (normal 140 degrees). Multiple tests for instability were negative. A NARSUM consult dated 2 November 2005, performed by an orthopedic specialist, noted subtle swelling, minimal crepitation with ROM and pain with increased flexion and no instability.

The commander’s statement dated 12 December 2005 indicated the CI’s “knees occasionally give out on her giving her the inability or difficulty to walk, climb stairs, climb on and off of vehicles, or lift heavy equipment. When standing in formations for extended periods of time her left knee swells up and causes her to limp and favor the left leg while walking.” The NARSUM dated 25 April 2006 (2 months prior to separation) referenced the orthopedic consult exam findings above and documented active ROM that was -3 to 122 degrees symmetrically on both knees (normal 0-140 degrees) with a normal gait. Imaging of the left knee documented advanced degenerative changes with retained screws from prior surgery. The PEB disability description indicated “progressively increasing pain with ambulation that prevents full duty function. Profile prohibits the majority of functional activities required of all Soldiers. R is full and consistent with the contralateral knee. No instability on stress testing. Rated for full motion.”

At the VA Compensation and Pension exam performed 4 months after separation, the CI reported constant pain and swelling with burning inside the knee. Activities and lifting increased the pain, as did standing from prolonged sitting. She complained of limited motion and flare-ups with severe pain of 9/10 3-4 times per week. She denied instability, weakened movement or lack of endurance. Exam documented a normal gait with heel walk and toe walk without difficulty. Scars were well healed and non-tender. Ligaments were stable with no evidence of instability or laxity (normal Lachman’s and Drawer tests). Motor strength, sensory exam and reflexes were normal on both legs. Active ROM was 0-140 degrees with no pain and no changes on repetition (no DeLuca issues). Radiographs documented osteoarthritis of both knees.

The Board directed attention to its rating recommendation based on the above evidence. The PEB rated the left knee condition at 0% coded 5003 (arthritis) while the VA rated the left knee along with other not unfitting joints (right knee osteoarthritis and conditions of the feet) combined as 5299-5010 (arthritis due to trauma) at 10%. The Service and VA both considered the Existed Prior to Service (EPTS) component of the left knee condition and, along with this Board, conceded permanent service aggravation without any EPTS deduction.

The orthopedic consult for the MEB documented painful motion, crepitus and swelling. The final NARSUM referenced and summarized that consult and provided an updated ROM without mentioning any repetition or the presence or absence of pain. The PEB’s description of ROM “consistent with contralateral side” did not account for the opposite knee also having documented arthritis (not “normal” or unaffected), and also indicated “increasing pain with ambulation” which would support §4.59 (painful motion). The Board considered that the PEB may have applied AR 635-40, B–29 (mechanical basis for restricted motion) for rating the knee and also adjudged that the orthopedic specialist exam had the highest probative value. Considering the totality of the evidence and mindful of VASRD §4.3 (reasonable doubt), §4.40 (functional loss) and §4.45 (the joints), 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 AR 635-40, B–29 for rating the left knee may have been operant in this case and the condition was adjudicated independently of that instruction by the Board. In the matter of the left knee condition, the Board unanimously recommends a disability rating of 10%, coded 5299-5010 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 her prior medical separation:

UNFITTING CONDITION
 VASRD CODE RATING
Chronic Left Knee Pain Secondary to Osteoarthritis 5299-5010 10%
COMBINED
 10%


The following documentary evidence was considered:

Exhibit A. DD Form 294, dated 20131107, w/atchs
Exhibit B. Service Treatment Record
Exhibit C. Department of Veterans’ Affairs Treatment Record








                 
XXXXXXXXXXXXXXXXX
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 XXXXXXXXXXXXXXXXX , AR20150007062 (PD201302422)
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                                                  XXXXXXXXXXXXXXXXX
                                                      Deputy Assistant Secretary of the Army
                                                      (Review Boards)

CF:
( ) DoD PDBR
( ) DVA

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