RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2013-01566
BRANCH OF SERVICE:  Army	BOARD DATE:  20141219
SEPARATION DATE:  20040912

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty O-3 (AG General) medically separated for chronic post-traumatic osteoarthritis of the left knee.  The condition could not be adequately rehabilitated to meet the physical requirements of his Military Occupational Specialty (MOS) 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 “chronic post-traumatic severe 3 compartment osteoarthritis left knee,” 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 post-traumatic osteoarthritis left knee with a chronic anterior cruciate ligament (ACL) deficiency” as unfitting, rating 20%, with likely application of the VA Schedule for Rating Disabilities (VASRD).  The CI made no appeals and was medically separated.

CI CONTENTION:  “The medical board only evaluated my left knee but at the time of separation I had other medical problems with my left shoulder, right knee and both ankles.”

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:

Service IPEB – Dated 20040609	VA - (3 1/2 Mos. Post-Separation)  	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Left Knee Osteoarthritis	5257	20%	Post Traumatic Arthritis, S/P Left Knee Arthroscopies	5260-5010	10%	20041229	
Other x 0 (Not In Scope)	Other x 3	
Combined:  20%	Combined:  30%	
Derived from VA Rating Decision (VARD) dated 20050719 (most proximate to date of separation [DOS]).

ANALYSIS SUMMARY:

Left Knee Condition.  The service treatment record revealed that the CI injured his left knee in basic training in 1990.  During the period of 1991 thru 2004, he underwent three separate surgeries on the left knee to include partial and complete menisectomies as well as boney debridement with instrumentation.  His X-rays consistently demonstrated moderate arthritis with small effusion.  Despite extensive physical therapy, his persistent symptoms of pain and feeling of instability remained and he was sent for MEB.  At the narrative summary (NARSUM) examination on 27 April 2004; 5 months prior to separation, the CI reported constant left knee pain with locking and give-way sensation.  The physical examination (PE) revealed full active range-of-motion (ROM).  Instability was present noting a positive pivot glide test under multiple testing techniques.  Crepitus and painful motion was present.  His diagnosis was post-traumatic severe osteoarthritis with past surgical description.  The commander’s statement noted that the CI’s limitations did prevent him from performing critical MOS duties or other Soldier duties outside the office environment.

At the VA Compensation and Pension examination on 29 December 2004, approximately 3 months after separation, the CI reported constant pain and swelling and commented that, “The knees buckle.”  He reported the inability of prolonged standing and admits to “incapacitation is two times a month, lasting three to five days.”  The PE revealed tenderness and painful minimally limited motion.  All cartilaginous and ligament instability tests were normal.  There was no joint effusion, crepitus or locking pain present.  Repeat X-rays remained unchanged.  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.

DOS 20040912
Left Knee ROM
(Degrees)	MEB ~ 4 Mo. Pre-Sep
(20040427) 	VA C&P ~ 3 Mo. Post-Sep
(20041229) 	
Flexion (140 Normal)	FROM	132	
Extension (0 Normal)	FROM	0	
Comment	(+) instability;
(+) crepitus;
painful motion	painful motion	
§4.71a Rating	20%	10%	

The Board directed attention to its rating recommendation based on the above evidence.  The PEB assigned a 20% rating under code 5257 (knee; other impairment) citing post-surgical intervention with instability upon physical testing.  The VA assigned a 10% rating under a dual code of 5260 (leg; limitation of flexion) and 5010 (traumatic arthritis) citing limited motion.  Although the ROM values remained fairly consistent and VASRD non-compensable in both pre and after separation examinations, it was their physical findings that were drastically different and inconsistent.  The NARSUM and VA examinations were in complete opposition with regards to the presence of knee laxity; present at the NARSUM and absent at the VA.  For purposes of the Board’s rating recommendation, Board members considered the probative value of these two examinations and concluded that both exams remained nearly equivalent in probative value as each was appropriately detailed and accurate.  Members deliberated on the level of laxity impairment.  Code 5257 (PEB’s choice) criterion is categorized into three levels of “slight” (10%), “moderate” (20%), and “severe” (30%) impairment.  Members considered and agreed that in light of the NARSUM’s description of measured laxity coupled with the VA’s finding of tenderness, the CI’s condition is best supported at a level greater than “slight” and less than “severe” laxity impairment. 
Absent greater instability, boney pathology, surgical mal-union, or worsening evidence of limited ROM, the Board agreed that there were no available alternative joint or analogous coding options which are applicable and or advantageous to the CI’s current 20% rating.  After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the Board concluded that although there are alternate coding pathways available, none would result in a higher rating currently applied by the PEB; and therefore, does not recommend a change in the PEB’s  adjudication 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.  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 re-characterization of the CI’s disability and separation determination.

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20140912, 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 XXXXXXXXXXXXXXXXXX, AR20150008337 (PD201301566)

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