RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXXXX	CASE:  PD-2014-00328
BRANCH OF SERVICE:  Army	SEPARATION DATE:  20040201

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an activated National Guard E-4 (Motor Transport Operator) medically separated for chronic left knee pain.  The condition could not be adequately rehabilitated to meet the physical requirements of his Military Occupational Specialty (MOS).  He was issued a permanent L3 profile and referred for a Medical Evaluation Board (MEB).  Chronic left knee pain was forwarded to the Physical Evaluation Board (PEB) IAW AR 40-501.  The MEB also identified and forwarded headaches; gastroesophageal reflux disease and diarrhea for PEB adjudication.  No other condition was submitted by the MEB.  The Informal PEB adjudicated chronic left knee pain as unfitting, rated 0% with application of the US Army Physical Disability Agency (USAPDA) pain policy.  The CI made no appeals and was medically separated.

CI CONTENTION:  “Anxiety, chronic sleep impairment and suspiciousness.”  The applicant’s complete submission, with attachments, is at Exhibit A.

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 condition outside the Board’s defined scope of review (such as the additional anxiety, chronic sleep impairment and suspiciousness conditions cited in the contention) and any contention not requested in this application may remain eligible for future consideration by the Board for Correction of Military 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:    

IPEB - Dated 20031218	VA* - (~4 Mos. Pre-Separation)	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Left Knee Pain	5099-5003	0%	Status-Post Left Knee Arthroscopy	5257	10%	20031022	
Other MEB/PEB Conditions x 3 (Not In Scope)	Other x 5	
RATING:  0%	RATING:  60%	
*Derived from VA Rating Decision (VARD) dated 20060207 (most proximate to date of separation [DOS])

ANALYSIS SUMMARY:

Chronic Left Knee Pain.  The record shows a primary care note dated 24 May 2001 documented the CI felt his left knee “pop” after he stepped into a hole.  The next record occurred on 24 April 2002 in orthopedics when the CI reported continued pain.  He was treated with medications, duty restrictions, physical therapy (PT), and pain injections without resolution.  On 12 June 2002 he had surgical resection of redundant tissue in the left knee.  In December, he was released for alternate physical fitness testing (walk vice run).  An orthopedic note on 29 September 2003 noted good range-of-motion (ROM).  Three weeks later, on 17 October 2003, a follow-up orthopedic appointment noted full ROM and a stable knee.  However, the CI stated that he could not do his job and was referred for an MEB.  During the MEB narrative summary (NARSUM) exam dated 17 October 2003, 3 months pre-separation, the CI reported his knee locked up and he was unable to climb into and out of trucks.  This examination evidence was taken from the last orthopedic appointment mentioned above.

At the VA Compensation and Pension (C&P) examination dated 22 October 2003 (1 week later) the CI reported constant pain, weakness, and giving way.  He denied the use of a brace or external device (cane or crutches).  On examination his posture was normal and he had a “slight limp on the limp.”  However, the heel and toe walk was normal.  The CI could squat, but it elicited pain.  Flexion was 135 degrees (normal 140) and painful.  The knee was stable, but the ligaments were painful when stressed.  Meniscal tear signs were absent.  Strength was reduced to 4/5 in flexion and extension.  The X-ray was normal.  No diagnosis was rendered.

The Board directed attention to its rating recommendation based on the above evidence.  The PEB rated the knee at 0%, coded 5099-5003 (Analogous to degenerative arthritis), citing the pain policy.  The VA rate the knee at 10%, coded 5257 (Knee, other impairment), for painful motion.  A 10% rating is supported by the presence of painful motion.  The Board considered these codes and others available for the knee and found no route to a rating higher than the 10% adjudicated by the VA.  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 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 was operant in this case and the condition was adjudicated independently of that policy by this Board.  In the matter of the left knee condition, the Board unanimously recommends a disability rating of 10%, coded 5257 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:

CONDITION	VASRD CODE	RATING	
Chronic Left Knee Pain	5257	10%	
RATING	10%	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20140109, 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 XXXXXXXXXXXXXXXXXXXXX, AR20160000176 (PD201400328)

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:

CF: 
(  ) DoD PDBR
(  ) DVA