RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXX	CASE:  PD-2013-01459
BRANCH OF SERVICE:  Army	BOARD DATE:  20141209
SEPARATION DATE:  20040826

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an activated National Guard SPC/E-4 (77F/Petroleum Supply Specialist) medically separated for left knee pain.  The left knee pain 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 “left knee pain status post patellar dislocation,” was forwarded to the Physical Evaluation Board (PEB) IAW AR 40-501.  No other conditions were submitted by the MEB.  The Informal PEB adjudicated “chronic left knee pain status post patellar dislocation,” as unfitting, rated at 10% with application of the US Army Physical Disability Agency (USAPDA) pain policy.  The CI made no appeals and was medically separated.

CI CONTENTION:  “Since my date of separation my keen pain progressively had gotten worse.  After numerous doctor appointments and several non-effective knee braces, I was finally told that a knee scope surgery was necessary.  Since surgery (8/2011) the pain has gotten worse.  The pain has caused hip and ankle problems on my left side.  This is causing problems with my civilian job which keeps me from progressing due to excruciating pain.” [sic]

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.  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.

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, operating under a different set of laws.

RATING COMPARISON:

Service IPEB – Dated 20040721	VA - (5 Mos. Post-Separation) 	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Left Knee Pain…	5099-5003	10%	Left Knee Strain	5299-5257	10%	20050118	
Other x 0  (Not in Scope)	Other x 0 	20050118	
Combined:  10%	Combined:  10%	
Derived from VA Rating Decision (VARD) dated 20050513 (most proximate to date of separation)

ANALYSIS SUMMARY:

Chronic Left Knee Pain Status Post Patellar Dislocation.  The CI injured his left knee while playing basketball and experienced a dislocated patella (knee cap).  Orthopedic evaluation on 22 January 2004 noted there was no prior history of patellar dislocation.  A magnetic resonance imaging performed on 22 January 2004, demonstrated a bruise of the lateral femoral condyle (thigh bone at the knee) and a partial tear of the lateral collateral ligament (strong ligament on the outer aspect of the knee).  The other ligaments (cruciate ligaments and medial collateral ligament) were intact and the menisci (cartilage) were normal.  The CI was treated with a knee immobilizer for a month followed by physical therapy.  At the time of follow-up orthopedic evaluation in May 2004, the CI reported that he continued to have knee pain that was prevented him from returning to full duty.  There was no report of recurrent patellar dislocation.  

The orthopedic MEB narrative summary on 20 May 2004 summarized the clinical history.  On examination, the left knee was tender with an effusion; the left knee flexion was 100 degrees, and extension 0 degrees.  There was no ligament instability (including anterior cruciate, posterior cruciate, medial collateral and lateral collateral ligaments), and a negative exam test for meniscus related symptoms.  Muscle strength for knee flexion and extension was normal.  

At the VA Compensation and Pension (C&P) examination on18 January 2005 (5 months after separation), the CI reported intermittent pain several times per week lasting 10 minutes interfering with activities including walking and lifting.  On examination the gait was normal.  Left knee flexion was 132 degrees (normal 140 degrees), and extension 0 degrees (normal 0 degrees).  There was pain at flexion of 132 degrees.  There was no change in range-of-motion (ROM) after repetition but the examiner stated there was functionally limiting pain.  The appearance of the knee was normal.  There was no ligament instability and examination test for meniscus related symptoms was negative.  An X-ray of the left knee on 18 January 2005 was normal.  The examiner concluded with diagnosis of left knee strain.

The Board directed attention to its rating recommendation based on the above evidence.  The PEB rated the chronic left knee pain status post patellar dislocation at 10%, coded 5099-5003 with application of the USAPDA pain policy noting the ROM and absence of instability.  The VA rated the left knee pain (left knee strain) at 10%coded 5299-5257(limitation of motion) based on the VA C&P examination citing painful motion (VASRD §4.59).  The MEB and the VA C&P examination ROM examinations did not demonstrate limitation of motion that supported a minimum rating under the VA Schedule for Rating Disabilities (VASRD) diagnostic code 5257 (limitation of motion).  There was evidence of painful motion (VASRD §4.59) and functional loss (VASRD §4.40) supporting a 10% rating.  There was no evidence of recurrent subluxation or instability to support consideration of rating under diagnostic code 5257 (other impairment recurrent subluxation or lateral instability) and no meniscus pathology for consideration under the codes 5258 and 5259, for meniscus disease.  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 adjudication for the chronic left knee pain status post patellar dislocation 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 chronic left knee pain status post patellar dislocation was operant in this case and the condition was adjudicated independently of that policy by the Board.  In the matter of the chronic left knee pain status post patellar dislocation 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 re-characterization of the CI’s disability and separation determination.

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20130918, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans’ Affairs Treatment Record

		

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 XXXXXXXXXXXXXX, AR20150006939 (PD201301459)

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						     
						         
CF: 
(  ) DoD PDBR
(  ) DVA