RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXX	CASE:  PD-2014-00062
BRANCH OF SERVICE:  Army	BOARD DATE:  20141105
SEPARATION DATE:  20060824

SUMMARY OF CASE:  The available evidence of record indicates that this covered individual (CI) was an active duty SSG/E-6 (11B/Infantryman) medically separated for left knee pain.  The condition could not be adequately rehabilitated to meet the requirements of his Military Occupational Specialty (MOS) or physical fitness standards, so he was issued a permanent L3 profile and referred for a Medical Evaluation Board (MEB).  The knee condition, characterized as “chronic left knee/thigh/calf posterior pain” 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 knee pain as unfitting, rated at 10% with likely application of the Veterans Affairs Schedule for Rating Disabilities (VASRD).  The CI made no appeals and was medically separated. 

CI CONTENTION:  “Conditions have continued to worsen and are now effecting my ability to work in physically demanding careers. ie. sitting, standing, kneeling for long periods of time. PTSD is effecting sleep habits and anger is effecting family”  

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 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 20060718	VA - (5 Mos. Post-Separation)	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Left Knee and Posterior Calf Pain	5261	10%	Residuals, Left Knee Strain	5099-5260	10%	20061219	
No Additional Conditions in Scope	No Other VA Conditions in Scope	
Combined:  10%	Combined:  20%	
Derived from Original VA Rating Decision (VARD) dated 20070212

ANALYSIS SUMMARY:  

Left Knee Condition.  The narrative summary (NARSUM) notes that the CI’s initial injury occur in March 2005 (approximately 17 months prior to separation), while performing physical training the CI developed posterior left knee pain with edema (swelling) that increased with extension.  An orthopedics’ NARSUM, the examiner noted initial left knee edema that self-resolved and no episodes of left knee locking, catching, or giving-way.  The CI reported that the left knee pain originated from the posterior mid-thigh into the mid-calf.  Diagnostic evaluation of the left knee included both X-rays and magnetic resonance imaging (MRI) studies, electromyography (EMG) of the lower extremities, a MRI of the lumbar spine and a bone scan.  All diagnostic studies were unremarkable with the exception of a small degenerative cyst of the knee joint (Baker’s cyst) and a metallic foreign body of unknown etiology in the quadriceps tendon.  The CI’s treatment for his left knee pain included physical therapy, a Botox injection (temporarily paralyze muscle activity) and a transcutaneous electrical nerve stimulation (TENS) unit.  With the exception of the TENS unit, the CI reported that the treatment provided significant pain control benefits.  An orthopedics’ surgery consultation indicated that the surgical procedure may not resolved symptoms; consequently the CI declined surgery at that time.

During the MEB examination dated 8 March 2006 (approximately 6 months prior to separation), the CI reported chronic posterior leg pain with constant muscle spasms.  The MEB examiner observed that the CI had an antalgic gait and a left knee flexed of 15 degrees.  The CI’s left knee could be manually fully extended also the examiner noted muscle spasm from the mid-thigh to mid-calf.  Left lower extremity (LE) reflexes and sensation were normal.  Examination of the left hip was unremarkable.  Physical therapy’s ROM measurements dated 14 March 2006 recorded an extension/flexion of 3 degrees to 116 degrees, 3 degrees to 115 degrees and 3 degrees to 112 degrees.  The MEB’s orthopedic examination dated 6 April 2006 noted an antalgic gait, tenderness to palpation posterior thigh just above the left knee, with full knee flexion and a lack of extension of 5 degrees to 10 degrees.  The left knee was stable, without evidence of cartilage injury, patellar tenderness or crepitus.  LE strength, sensation and reflexes were intact.

The VA Compensation and Pension (C&P) examination dated 19 December 2006 performed 4 months post separation, the CI reported left leg pain that began in left thigh, ran down into ankle and was aggravated by activity.  He reported no dislocations, time missed from work and ability to perform his activities of daily living (ADL).  The C&P examiner noted normal posture and gait with full extension of the left leg and a flexion of 130 degrees.  The C&P examiner noted painful joint motion but left knee was without tenderness to palpation instability or weakness.  

The Board directs attention to its rating recommendation based on the above evidence.  The PEB rated the left knee condition at 10%, coded 5261 (limited leg extension) and the VA rated the left knee condition at 10%, coded 5099-5260 (analogous to limited leg flexion).  The Board agreed that the CI’s left knee condition was most appropriately coded as 5261 (limited leg extension) and the evidence supported the 10% rating for a lack of extension ROM of 10 degrees.  The Board reviewed available evidence for a possible higher rating determination of 20% by considering the MEB’s examiner notation of the left knee lack of extension of 15 degrees.  However, the following three ROM evaluations (physical therapy, orthopedics and VA’s C&P) noted extension limited of 0 degrees to 10 degrees.  Members agreed that the preponderance of the evidence supported the 5261 (limited leg extension) at 10% rating for extension limited by 10 degrees and not an rating of 20% for extension limited by 15 degrees.  There was no indication in the service treatment record of any other ratable impairment to provide for higher or additional rating.  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 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 recharacterization of the CI’s disability and separation determination.  

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20131216, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans’ Affairs Treatment Record

		
XXXXXXXXXXXXXXX
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 XXXXXXXXXXXXXXX, AR20150003736 (PD201400062)

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						     XXXXXXXXXXXXXXX
						     Deputy Assistant Secretary of the Army
						          (Review Boards)
						         
CF: 
(  ) DoD PDBR
(  ) DVA