RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXX	CASE:  PD-2014-00531
BRANCH OF SERVICE:  Army	BOARD DATE:  20150728
SEPARATION DATE:  20070627

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E-2 (Medical Care Specialist Trainee) medically separated for a left knee condition.  The condition could not be adequately rehabilitated to meet the physical requirements of his Military Occupational Specialty.  The profile allowed for an alternate aerobic event to satisfy physical fitness standards.  He was issued a permanent L3 profile and referred for a Medical Evaluation Board (MEB).  Left knee 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 chronic pain, left knee as unfitting, rated 10% with cited application of the US Army Physical Disability Agency (USAPDA) pain policy.  The CI made no appeals and was medically separated.

CI CONTENTION:  The CI elaborated no specific contention in his application.

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:

IPEB – Dated 20070618	VA* - (~2 Mos. Post-Separation)  	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Pain, Left Knee	5099-5003	10%	Torn Left Lateral Meniscus with Cyst Status-Post Surgical Repair	5299-5259	10%	20070816	
Other MEB/PEB Conditions x 0 (Not In Scope)	Other x 0	
RATING:  10%	RATING:  10%	
*Derived from VA Rating Decision (VARD) dated 20080204 (most proximate to date of separation [DOS])

ANALYSIS SUMMARY:

Left Knee Condition.  The CI sustained a left knee injury while running in April 2006 and required surgery in October 2006 for debridement and repair of a lateral meniscal tear and removal of a large meniscal cyst.  Post-operatively he did well until January 2007 when he slipped and fell, re-injuring the knee.

The MEB narrative summary on 23 March 2007 (3 months prior to separation) reported ongoing complaints of pain, swelling and instability.  Examination noted no swelling, crepitus or patellar grind.  All ligaments were stable.  Joint line tenderness was present.  A magnetic resonance imaging (MRI) study on 5 April 2007 showed a lateral meniscus tear which could represent a new injury, or post-operative changes.  Ligaments were normal except for some thickening of the collaterals.  At an orthopedic follow-up evaluation on 11 April 2007 the CI complained of giving way of the knee, but denied locking or catching.  Exam showed slight knee tenderness and no swelling.  All knee ligaments were intact.  The examiner opined that the recent MRI findings were most likely due to post-operative changes.

At the VA Compensation and Pension exam performed 2 months after separation the CI reported that he could not return to his previous work as an emergency medical service technician and fireman because of his left knee pain.  Examination showed a slightly limping gait, favoring the left knee.  There was mild knee tenderness but no swelling.  Repetitive motion did not result in additional loss of motion.  There was no knee instability.

The goniometric range-of-motion (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.

Left Knee ROM
(Degrees)	MEB ~3 Mos. Pre-Sep	PT ~1 Mo. Pre-Sep	VA C&P ~2 Mos. Post-Sep	
Flexion (140 Normal)	140	130	140	
Extension (0 Normal)	0	0	0	
Comment		+Painful motion, antalgic gait	+Painful motion	
§4.71a Rating	0%	10%*	10%*	
	*IAW VASRD §4.40 (functional loss) or §4.59 (painful motion)

The Board directed attention to its rating recommendation based on the above evidence.  The PEB assigned a 10% rating coded analogously to 5003 (degenerative arthritis), while the VA also rated at 10% under an analogous 5259 code (Cartilage, semilunar, removal of, symptomatic).  Although there was no compensable limitation of motion, there was sufficient evidence of pain with use §4.40 (Functional loss) and §4.59 (Painful motion) to justify a minimal compensable rating under §4.71a.  A 10% rating was also justified via the 5259 coding pathway for persistence of pain status post meniscal cartilage debridement.  There was no evidence of knee instability to warrant a rating under the 5257 code (Knee, other impairment of), and no evidence of dislocated cartilage with frequent episodes of locking and effusion to justify a rating under the 5258 code.  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 left knee pain 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 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 chronic pain, 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 20140110, 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 XXXXXXXXXXXXXXXXXXXXXXX, AR20160000257 (PD201400531)

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:

Enclosure

CF: 
(  ) DoD PDBR
(  ) DVA