RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXX	CASE:  PD-2014-00232
BRANCH OF SERVICE:  Army	BOARD DATE:  20150211
Separation Date:  20071114

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty serve E-1 (Motor Transport Operator) medically separated for left knee condition.  This condition not be adequately rehabilitated to meet the physical requirements of his Military Occupational Specialty.  He was issued a permanent L3 profile and referred for a Medical Evaluation Board (MEB).  The left knee condition, characterized as “chronic left knee pain, patellofemoral pain syndrome (PFPS),” was forwarded to the Physical Evaluation Board (PEB) IAW AR 40-501.  No other condition was submitted by the MEB.  The Informal PEB adjudicated left knee pain as unfitting, rated 0% with cited application of the US Army Physical Disability Agency (USAPDA) pain policy.  The CI made no appeals and was medically separated.

CI CONTENTION:  “I was offered 10% from VA for 2 pilonidal cystectomy’s.  I have no rating on knee (partial tear in ACL) = Reason for discharge”

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 20070801	VA* - (4.5 Mos. Post-Separation)	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Left Knee Pain PFPS	5099-5003	0%	Incomplete Tear, Left ACL, Left Knee	5299-5262	0%	20080328	
Other x0	Other x3 (Not in Scope)	
Combined:  0%	Combined:  10%	
*Derived from VA Rating Decision (VARD) dated 20081218 (most proximate to date of separation (DOS))

ANALYSIS SUMMARY:

Left Knee Pain Condition.  The CI injured his left knee during a training run in March 2006 when he felt a pop in his left knee and had to drop out due to significant pain.  The primary care provider noted lower leg pain at the proximal one third of the tibia area.  A left leg X-ray performed on 3 March 2006 was normal.  A repeat left knee X-ray was normal.  The physical therapist (PT) documented that the CI was doing remedial PT two times a day.  The PT noted supra patella and lateral patella region pain, aggravated by going upstairs, jumping, standing, sitting and biking with pain that ranged from 6/10 to 8/10.  There were physical exam findings of antalgic limp with decreased stance time; range-of-motion (ROM) limited to 3-113 degrees, and positive patella femoral compression.  The PT noted a continued antalgic gait, an inability to correct the gait, limited ROM to 122 degrees and ROM limited pain.  The examiner diagnosed patellofemoral pain.  The left knee magnetic resonance imaging showed possible mild chondromalacia changes and a possible partial tear of the anterior cruciate ligament near its insertion into the tibia.  The CI was given a left knee steroid injection, however there was no improvement noted.  The PT noted that the CI had an antalgic gait, decreased strength in hip extension, very tight hip flexors and a slouched posture.  The left knee X-ray was normal.  The PT performed ROMs for the MEB exams that are summarized in the chart below.  The MEB narrative summary (NARSUM) exam approximately 4 months prior to separation documented that the CI reported left knee pain worsening rated at 8/10 that occurred with standing or walking.  The MEB NARSUM physical exam findings are summarized in the chart below.  The VA Compensation and Pension (C&P) exam approximately 4 months after separation documented that the CI continued to have pain and pain with weight bearing which caused limping, and flare-ups with any increased activity such as lifting.  The VA C&P physical exam findings are summarized in the chart below.  

Left Knee ROM (Degrees)	PT Exam ~6 Mos. Pre-Sep	NARSUM ~4.5 Mos. Pre-Sep	VA C&P 4.5 Mo. Post-Sep	
Flexion (140 Normal)	105 	Referred to PT ROMs obtained 22 May 2007	135	
Extension (0 Normal)	0 		0	
Comment	Pos. painful motion	Pos. painful motion & tenderness to palpation; No instability; Pos. crepitus	Pos. antalgic gait; No painful motion; No instability	
§4.71a Rating	10%*	10%* (PEB 0%)	0% (VA 0%)	
* IAW VASRD §4.59, Painful motion

The Board directed attention to its rating recommendation based on the above evidence.  The PEB coded the left knee pain condition as 5009 analogous to 5003 (degenerative arthritis) and rated 0% with application of the USAPDA pain policy.  The VA coded the incomplete tear, left anterior cruciate ligament, left knee condition as 5299 analogous to 5262 (impairment of tibia and fibula) and rated at 0%.  The prior to separation PT and NARSUM exams both document non-compensable ROM measurements with the presence of painful motion in the left knee.  VASRD §4.71a specifies for 5003 that “satisfactory evidence of painful motion” constitutes limitation of motion and specifies application of a 10% rating “for each such major joint or group of minor joints affected by limitation of motion” and VASRD §4.59 (Painful motion) provides an alternate justification for a 10% rating.  There was no evidence of instability or any knee specific condition that could be reasonably rated higher than 10% using any exam proximate to separation or any alternate rating schema.  After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the Board recommends a disability rating of 10% for the left knee pain PFPS 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 left knee pain condition was operant in this case and that condition was adjudicated independently of that policy by the Board.  In the matter of the left knee pain condition, the Board unanimously recommends a disability rating of 10%, coded 5099-5003 IAW VASRD §4.71a.  There were no other conditions within the Board’s scope of review for consideration.

RECOMMENDATION:  The Board recommends that the CI’s prior determination be modified as follows, effective as of the date of his prior medical separation:

UNFITTING CONDITION	VASRD CODE	RATING	
Left Knee Pain with PFPS	5099-5003	10%	
COMBINED	10%	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20140103, 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 AR20150011010 (PD201400232)

1.  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 to modify the individual’s disability rating to 10% without recharacterization of the individual’s separation.  This decision is final.  

2.  I direct that all the Department of the Army records of the individual concerned be corrected accordingly no later than 120 days from the date of this memorandum.   

3.  I request that a copy of the corrections and any related correspondence be provided to the individual concerned, counsel (if any), any Members of Congress who have shown interest, and to the Army Review Boards Agency with a copy of this memorandum without enclosures.

 BY ORDER OF THE SECRETARY OF THE ARMY:

Encl		     

CF: 
(  ) DoD PDBR
(  ) DVA