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AF | PDBR | CY2013 | PD2013 00322
Original file (PD2013 00322.rtf) Auto-classification: Approved
RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME: XXXXXXXXXXXXXXXXXX         CASE: PD1300322
BRANCH OF SERVICE: Army BOARD DATE: 20130911
SEPARATION DATE: 20020226


SUMMARY OF CASE: Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty SPC/E-4 (14T, Patriot Launching Station Enhanced Operator/Maintainer) medically separated for a left knee condition. The CI reported a history of left knee pain and underwent an arthroscopy in April of 2001. He was treated conservatively but his 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 left knee condition, characterized as “chondromalacia, left knee” was forwarded to the Informal Physical Evaluation Board (IPEB) IAW AR 40-501. No other conditions were submitted by the MEB. The IPEB adjudicated “chondromalacia of the left knee” as unfitting, rated 0%. The CI initially decided to appeal to the Formal PEB but withdrew his request and was medically separated.


CI CONTENTION: “I received a 0% rating but I feel like it should be changed because I’ve had two more surgeries for the same problem and now it has affected my job, with the post office, I can’t walk on it that long, can’t stand, it locks up and swells bad. It also has cause my right knee and my right hip to go bad and now my knee (right) need surgery, and my hip need a replacement. My job has also basically forced me to put in my medical retirement, because, of all the profiles, and my condition. My supersors [sic] also has given me light duty sometimes because of all the pain I be in, and cause I’m able to do walking routes. I also just come back from worker comp.”


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 Service rating for the unfitting left knee condition is addressed below; and, no additional conditions are within the DoDI 6040.44 defined purview of the 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.


RATING COMPARISON:

Service IPEB – Dated 20011105
 VA - (13 Mos. Post-Separation)
Condition
 Code Rating Condition Code Rating Exam
Chondromalacia, L Knee
 5099-5003 0% Degenerative Joint Disease L Knee 5260-5257 10% 20030320
No Additional MEB/PEB Entries
 Other x2 20030320
Rating: 0%
 Combined: 10%
Derived from VA Rating Decision (VA RD ) dated 200 30619 (most proximate to date of separation [ DOS ] )


ANALYSIS SUMMARY: The Board acknowledges the CI’s information regarding the significant impairment with which his service-connected condition continues to burden him; but, must emphasize that the military Disability Evaluation System has neither the role nor the authority to compensate service 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.

Left Knee Condition. The CI noted the onset of left knee pain during Advanced Individual Training sometime in late 1999. There was no acute injury noted. He was treated conservatively without resolution of his symptoms and underwent arthroscopic evaluation of the left knee in April 2001. There is no operation report available in evidence; however, service treatment records (STR) suggest that chondromalacia patella (a general term indicating damage to the cartilage under the kneecap) was found during the procedure. The MEB physical exam performed 7.5 months prior to separation noted tenderness and crepitation of the left knee without effusion. The narrative summary (NARSUM) prepared 4.5 months prior to separation noted the CI was followed postoperatively and did not have significant improvement after the arthroscopy. He had difficulty with running, jumping, climbing on and off ladders, climbing on and off of tactical vehicles and doing an Army Physical Fitness Test for all three events. The physical exam findings are summarized in the chart below. At the VA Compensation and Pension (C&P) exam performed 13 months after separation, the CI reported the pain in the left knee had gotten worse, pain noted at least once per week and sometimes more often. The pain lasted a few hours and sometimes much longer and interfered with his daily activities and his occupation. Periodically, he also had swelling of the left knee and buckling or giving out. The CI took Motrin as needed and got minimal to no relief.

The goniometric range-of-motion (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) MEB ~ 4 Mo. Pre-Sep VA C&P ~ 13 Mo. Post -Sep
Flexion (140 ° Normal) 135 ° 130 °
Extension (0 ° Normal) - 10 °
Comment No effusion left knee; Negative signs of instability; Mild joint line tenderness near the portals 2+ crepitation; No swelling; Mild varus deformity; Mild atrophy of the quadriceps muscles ; 2+ laxity w/ some lateral instability ; Pos. painful motion

The Board directs attention to its rating recommendation based on the above evidence. The PEB applied the analogous VASRD code of 5099-5003, degenerative arthritis, and rated it 0% citing “…stable ligaments but restricted from vigorous use of leg.” The VA applied the analogous code of 5260-5257, 5257 knee, other impairment of (recurrent subluxation or lateral instability) and rated it 10% citing “…the record shows recurrent subluxation or lateral instability of the knee which is slight.” The C&P exam does document “some lateral instability” however the STR does not support any episodes of instability or prior physical exam findings consistent with joint instability. The STR also does not support the use of any knee specific VASRD code based on ROM measurements, ankylosis or meniscal pathology. Chondromalacia represents a “pathological softening” of the cartilage while Osteomalacia represents a pathological softening of the bone and are closely related disease entities with similar symptomatology to allow for analogous rating IAW §4.20 (analogous ratings). Osteomalacia, VASRD code 5014, refers to code 5003 for rating criteria as referenced below for the reader’s convenience:

5003 Arthritis, degenerative (hypertrophic or osteoarthritis):
Degenerative arthritis established by X-ray findings will be rated on the basis of limitation of motion under the appropriate diagnostic codes for the specific joint or joints involved (DC 5200 etc.). When however, the limitation of motion of the specific joint or joints involved is noncompensable under the appropriate diagnostic codes, a rating of 10 pct is for application for each such major joint or group of minor joints affected by limitation of motion, to be combined, not added under diagnostic code 5003. Limitation of motion must be objectively confirmed by findings such as swelling, muscle spasm, or satisfactory evidence of painful motion. In the absence of limitation of motion, rate as below:

With X-ray evidence of involvement of 2 or more major joints or 2 or more minor joint groups, with occasional incapacitating exacerbations ................................................ 20
With X-ray evidence of involvement of 2 or more major joints or 2 or more minor joint groups ........................................................ 10

In this case, there were no compensable ROM findings or X-ray evidence of degenerative arthritis of the left knee. However, crepitation was documented during the MEB exam before separation, satisfying the §4.59 criteria for painful motion and meeting the 10% rating under 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 chondromalacia 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. The Board did not surmise from the record or PEB ruling in this case that any prerogatives outside the VASRD were exercised. In the matter of the Chondromalacia of left knee condition, the Board unanimously recommends a disability rating of 10%, coded 5299-5014 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:

UNFITTING CONDITION VASRD CODE RATING
Chondromalacia Left Knee 5299-5014 10%
COMBINED 10%


The following documentary evidence was considered:

Exhibit A. DD Form 294, dated 20130511, w/atchs
Exhibit B. Service Treatment Record
Exhibit C. Department of Veterans’ Affairs Treatment Record





XXXXXXXXXXXXXXXXXX
President
Physical Disability Board of Review
SFMR-RB                                                                         


MEMORANDUM FOR Commander, US Army Physical Disability Agency
(TAPD-ZB / XXXXXXXXXXXXXXXXXX ), 2900 Crystal Drive, Suite 300, Arlington, VA 22202-3557


 SUBJECT: Department of Defense Physical Disability Board of Review Recommendation
for XXXXXXXXXXXXXXXXXX, AR20130021836 (PD201300322)
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                                                  XXXXXXXXXXXXXXXXXX
                                                      Deputy Assistant Secretary
                                                      (Army Review Boards)

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