RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2013-01866
BRANCH OF SERVICE:  Army	BOARD DATE:  20140806
SEPARATION DATE:  20041130

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty SPC/E-4 (31B1O/Military Police) medically separated for a right knee condition.  He was issued a permanent L3 profile and referred for a Medical Evaluation Board (MEB).  The right knee condition, characterized as “chronic pain, right knee, status post-surgical procedures,” was forwarded to the Physical Evaluation Board (PEB) IAW AR 40-501.  The MEB also identified and forwarded five other conditions.  The Informal PEB adjudicated chronic pain, right knee condition as unfitting, rated 10%, with cited application of the US Army Physical Disability Agency (USAPDA) pain policy.  The remaining conditions were determined to be not unfitting.  The CI made no appeals and was medically separated.

CI CONTENTION:  “Rating was based upon it being a pre-existing condition aggravated by service.  Previously there was a single knee surgery when I was 16 yrs old that was an arthroscope that removed a small bone chip following a dislocation of my knee.  There was no further issue until l began experiencing a different (continued) issue with the knee giving way after long runs, this issue had never previously occurred and I fail to see how it can be related to a minor injury 5 years prior.  This began a series of several knee surgeries that progressively made my issue worse.  Prior to this injury I enjoyed running and did very well on those portions of my PT tests.  After release from service I began to have issues with my lower back and left knee as a result of the right knee and favoring it.”

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 right knee condition is addressed below.  The not unfitting conditions were not contended; and, thus are not within the DoDI 6040.44 defined purview of the Board.  The contended low back and left knee conditions were not identified by the MEB or PEB and, thus are not within the Board’s purview.  These, and any other condition or contention not requested in this application, 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.  The Board also acknowledges the CI’s contention that suggests a higher rating should be granted for medical conditions identified by the CI post separation.  IAW DoDI 6040.44, the Board’s authority is limited to making recommendations on correcting disability determinations.  The Board’s role is thus confined to the review of medical records and all evidence at hand to assess the fairness of PEB rating determinations, compared to VA Schedule for Rating Disabilities (VASRD) standards, based on ratable severity at the time of separation; and, to review those fitness determinations within its scope (as elaborated above) consistent with performance-based criteria in evidence at separation.

RATING COMPARISON:

Service IPEB – Dated 20040915	VA* - (33 Mos. Post-Separation)	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Pain, Right Knee	5099-5003	10%	Right Knee Patellofemoral Pain Syndrome	5010	10%	20070912	
Other x 5 (Not in Scope)	Other x 0	20070912	
Combined:  10%	Combined:  10%	
*Derived from VA Rating Decision (VARD) dated 20070921 (most proximate to date of separation (DOS))

ANALYSIS SUMMARY:

Chronic Pain, Right Knee.  The first entry in the record is from the 4 April 1999 Military Entrance Processing Station’s orthopedic evaluation for history of bilateral patellar subluxations requiring surgeries.  The consultant documented injuries to the right knee and arthroscopic surgery 2 years prior and the left knee with arthroscopic surgery performed 9 months prior.  There were no further incidents of patellar subluxation and he was active in sports.  The next entry was on 19 February 2003 for bilateral knee pain for a year for which the CI was referred to orthopedics.  On 4 June 2002, the CI underwent a right knee arthroscopy with lateral release and excision of patellar fragment.  He continued to experience right knee pain after undergoing physical therapy.  On 17 April 2003, the CI underwent another right knee arthroscopy, lengthening of the quadriceps tendon and a distal tibial tubercle transfer.  He continued to have pain with prolonged walking and with stairs.  He had another right knee arthroscopy, patellar chondroplasty and arthroscopic lateral release on 1 April 2004.  There was intraoperative evidence of right patellar Grade II to Grade III chondromalacia by inspection during the surgery.  The CI continued with PT and on his own at the gym.  On 10 May 2004, the orthopedic surgeon opined he was unlikely to resume unrestricted activities in the near future.  On 4 August 2004, the CI fell down five stairs when his right knee gave way.

At the MEB narrative summary examination dated 17 August 2004, 3 months prior to separation, the CI reported continuous pain and tenderness of the right knee.  He stated the knee would lock and buckle.  The buckling caused a fall down the stairs.  Pain was exacerbated by prolonged walking, running or climbing.  He demonstrated inability to do significant field or military activities requiring more than sedentary functionality.  He was restricted to desk, non-field duty.  Physical examination found 5/5 strength for bilateral knee flexion and extension.  The right knee was stable with negative Lachman’s test, negative McMurray’s test and negative varus/valgus stress test.  There was significant atrophy of the quadriceps muscles over the right knee and bilateral surgical scars noted.  Ranges-of-motion (ROM) were 0 to 145 degrees (140 is normal).  There was no VA Compensation and Pension examination proximal to the date of separation in the record.

The Board directs attention to its rating recommendation based on the above evidence.  The Board considered VASRD diagnostic codes 5099-5003 (rated analogously to degenerative arthritis) used by the PEB for a 10% rating.  There were no compensable ROM which were measured as normal.  There was no evidence for a higher rating in the record.  The Board considered code 5257 (knee, other impairment of) due to reported instability and locking without subluxation or lateral instability by examination and found no rating advantage to the CI above 10%.  The Board considered this code (5257) to be more descriptive of the condition, but did not find a rating advantage.  Consideration of a §4.73 muscle rating was also considered in view of quadriceps muscle atrophy, but with 5/5 strength by examination, no rating advantage was found above 10%.

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 pain, right 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 the USAPDA pain policy for rating the chronic pain, right knee condition was operant in this case and the condition was adjudicated independently of that policy by the Board.  In the matter of the chronic pain, right 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 20130920, 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 XXXXXXXXXXXXXXX, AR20150001204 (PD201301866)

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