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AF | PDBR | CY2013 | PD2013 01270
Original file (PD2013 01270.rtf) Auto-classification: Denied
RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME: XXXXXXXXXXXXXXXXXX         CASE: PD1301270
BRANCH OF SERVICE: Army  BOARD DATE: 20140219
Date of SEPARATION: 20040608


SUMMARY OF CASE: Data extracted from the available evidence of record reflects that this covered individual (CI) was an activated National Guard SGT/E-5 (92A/Automated Logistical Supply Maintenance) medically separated for post-traumatic arthritis of the left knee. The original injury took place in October 2001 when the CI was involved in a motor vehicle accident (MVA) and sustained a left knee/leg fracture. He underwent surgery and was doing well until re-injuring the same area in March 2003. 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 left knee/leg condition, characterized as “post-traumatic arthritis of the left knee, status post open reduction internal fixation of a tibial plateau fracture” was forwarded to the Physical Evaluation Board (PEB) IAW AR 40-501. No other conditions were submitted by the MEB. The Informal PEB adjudicated the left knee post-traumatic arthritis condition as unfitting, rated 10%. The CI made no appeals and was medically separated


CI CONTENTION: “The initial rating was given to out process quickly and was not reviewed by the rest of the board. Because of my injury I cannot work. Most jobs require lifting or long term standing and my leg will not allow it. I have to ride a bicycle for exercise since I cannot run or walk for long periods and I still have periodic pain that keeps me from enjoying day to day life.”


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; and, no additional conditions are within the DoDI 6040.44 defined purview of the Board.


 RATING COMPARISON :

Service IPEB – Dated 20040512 VA - based on Service Treatment Records (STR)
Condition Code Rating Condition Code Rating Exam
Post-traumatic Arthritis Lt Knee 5010 10% Post-traumatic Arthritis Lt Knee 5010-5260 10% STR
No Additional MEB/PEB Entries Other x 1 STR
Rating: 10% Rating: 10%
Derived from VA Rating Decision (VA RD ) dated 200 40723 ( 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 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 (DVA). The DVA, operating under a different set of laws (Title 38, United states Code), is empowered to compensate service-connected conditions and to periodically re-evaluate said conditions for the purpose of adjusting the Veteran’s disability rating should the degree of impairment vary over time. Any conditions 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 (BCMR). It is furthermore noted for the record that the Board has neither the jurisdiction nor authority to scrutinize or render opinions in reference to the CI's contended statement in the application regarding his initial rating “…was not reviewed by the rest of the board.” That authority also resides with the BCMR.

Left Knee Condition. The CI sustained a fracture of his tibial plateau (top of the lower leg bone at the knee) left knee in a MVA in October 2001 which required surgical fixation with instrumentation. The service treatment record (STR) was void of source documents from 2001, and record documentation began in May 2003 when he re-injured/hyperextended his left knee when he slipped in a water puddle. X-rays revealed previous surgical hardware in-place and a small effusion (abnormal accumulation of fluid) without new fracture. Range-of-motion (ROM) was extension/flexion of 0-120 degrees. On 6 May 2003, physical therapy (PT) noted full, but painful ROM. Despite aggressive PT and local steroid injections, his knee pain continued. The goniometric 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 ~6 Mo. Pre-Sep (20031218) MEB ~3 1/2 Mo. Pre-Sep
(20040225)
Flexion (140 Normal) 120 120
Extension (0 Normal) 0 0
Comment tenderness; no instability; tenderness; no instability;
§4.71a Rating NR NR

At the narrative summary examination of 25 February 2004, (4 months prior to separation), the CI reported increasing left knee pain with severe intensity. Examination revealed diffuse tenderness over the lateral aspect of the left knee. ROM was flexion to 120 degrees and all tests for laxity or instability were normal. There was no joint swelling or effusion noted. The examiner opined that the CI’s condition had reached maximal benefit to treatment and was “stable.” The diagnosis was post-traumatic arthritis, left knee; status-post surgical fixation of tibial plateau fracture. There were no VA examinations in evidence and the original VARD of 23 July 2004 (based upon STR’s) indicated a 10% disability rating citing painful motion secondary to a permanent worsening of a prior knee condition.

The Board directs attention to its rating recommendation based on the above evidence. Although non-compensable limitation of motion was present, the ratings by the PEB and the VA were supported by evidence of pain with use (§4.40) or painful motion (§4.59). The Board considered a higher rating under the 5262 code (tibia and fibula, impairment). Board members agreed however that the evidence elaborated above does not reflect a “moderate” level of knee disability, and therefore a 20% rating is not justified under that code. After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the Board concluded that there was insufficient cause to recommend a change in the PEB’s adjudication for the post-surgical fixation of the left tibial plateau fracture 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 left knee condition and IAW VASRD §4.71a, the Board unanimously recommends no change in the PEB adjudication. There were no other conditions within the Board’s scope of review for consideration.


RECOMMENDATION: The Board, therefore, recommends that there be no recharacterization of the CI’s disability and separation determination, as follows:

UNFITTING CONDITION VASRD CODE RATING
Post-traumatic Arthritis Left Knee 5010 10%
RATING 10%


The following documentary evidence was considered:

Exhibit A. DD Form 294, dated 20130913, w/atchs
Exhibit B. Service Treatment Record
Exhibit C. Department of Veterans’ Affairs Treatment Record




XXXXXXXXXXXXXXXXXX
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 XXXXXXXXXXXXXXXXXX, AR20140013998 (PD201301270)

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 and hereby deny the individual’s application.
This decision is final. The individual concerned, counsel (if any), and any Members of Congress who have shown interest in this application have been notified of this decision by mail.

BY ORDER OF THE SECRETARY OF THE ARMY:




Encl                                                  XXXXXXXXXXXXXXXXXX
                                                      Deputy Assistant Secretary
                                                      (Army Review Boards)

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