RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME: XXXXXXXXXXXXXXXXXXXXXXX	    CASE:  PD-2014-00597
BRANCH OF SERVICE:  Army	SEPARATION DATE:  20050714

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E-5 (Commissioned Officer Candidate) medically separated for a left knee condition.  The condition could not be adequately rehabilitated to meet the physical requirements of her Military Occupational Specialty (MOS).  She was issued a permanent L3 profile and referred for a Medical Evaluation Board (MEB).  The “left knee pain” and “patellofemoral syndrome,” were 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 application of the US Army Physical Disability Agency (USAPDA) Pain Policy.  The CI made no appeals and was medically separated.  

CI CONTENTION:  Her knee condition continues to worsen and negatively impacts her daily activities.  Additionally, she was not evaluated for her low back and hearing conditions.  Her complete submission 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 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 20050606	VA* - (~2 Mos. Pre-Separation)  	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Pain, Left Knee	5099-5003	10%	Residual, S/P ACL Repair, L Knee	5260	10%	20050524	
Other MEB/PEB Conditions x 0 (Not In Scope)	Other x 3 	
RATING:  10%	RATING:  10%	
*Derived from VA Rating Decision (VARD) dated 20050912 (most proximate to date of separation (DOS).  

ANALYSIS SUMMARY:  

Chronic Pain, Left Knee Condition.  The record shows that the CI had surgical repair of the left anterior cruciate ligament (ACL, an internal ligament providing stability in the knee) and medial meniscus (an internal cartilage cushion) in 2002, prior to service.  She was also noted to have a discoid lateral meniscus, a congenital variant.  She enjoyed a full recovery, but did continue to have intermittent pain.  The injury and repair were reported and medically waived prior to accession.  Shortly after beginning basic training, she had recurrent left knee pain.  She was recycled in training and was then able to complete basic training and began Officer Candidate School.  She had recurrent pain with the increased activity level and was unable to complete training.  A primary care note dated 30 September 2004 recorded a full, but painful range-of-motion (ROM) and a stable knee without signs of meniscal irritation.  The examination was essentially unchanged at the primary care visits on 6 December 2004 and 7 January 2005.  X-rays on 7 January 2005 showed post-surgical changes.  The ROM was reduced secondary to pain at the 15 March 2005 at the primary care appointment, but again full on 28 March 2005.  The examination that day also showed a stable knee without signs of meniscal irritation.  An MRI on 4 April 2005 documented the prior ACL and meniscal repairs, as well as degeneration of the lateral meniscus and the ACL graft.  The narrative summary (NARSUM) was dated 12 April 2005 and noted that the ROM was slightly reduced at 130 degrees of flexion and 5 degrees of hyper-flexion.  The knee was stable and without signs of meniscal irritation.  Painful motion was not documented on the examination.  She reported pain with running and walking if wearing boots.  

At the VA Compensation and Pension (C&P) examination performed on 24 May 2005, 2 months before separation, the CI reported constant pain, but denied incapacitation.  She was able to garden and push a lawn mower.  On examination, her gait and posture were normal and she did not use an assistive device.  The ROM was reduced and limited by pain as charted below.  The ROM did not decrease further with repetitive use.  The knee was stable and without signs of meniscal irritation.  A second VA C&P examination was performed on 2 March 2006, 7 months after separation.  She had a mild limp, but her knee was stable and without meniscal signs.  The ROM was improved from the prior C&P, but did decrease 10 degrees in flexion with repetition.  Locking was not documented.  The goniometric 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)	PT ~10 Mos. Pre-Sep	Ortho/MEB
~3 Mos. Pre-Sep	VA C&P ~2 Mos. Pre-Sep	VA C&P ~8 Mos. Post-Sep 	
Flexion (140 Normal)	Full Range of Motion	130	85	115	
Extension (0 Normal)		0	0	0	
Comment	Painful Motion	Painful Motion not recorded	Painful Motion	Painful Motion	
§4.71a Rating	10%	0%	10%	10%	

The Board directed its attention to its rating recommendation based on the above evidence.  The PEB and VA both rated the knee at 10%, coded 5099-5003 (analogous to degenerative arthritis) and 5260 (limitation in flexion), respectively.  The ROM was not compensable on any examination and instability was absent.  Painful motion supports a 10% rating.  The Board found no route to a higher rating.  After due deliberation in consideration of the preponderance of the evidence, the Board concluded that there was insufficient cause to recommend a change in the PEB adjudication for the 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 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 pain 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 20140121, 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, AR20160002897 (PD201400597)

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