RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXXXX	CASE:  PD-2014-01211
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20060530

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E6, Chemical Operations Specialist, medically separated for “left knee retropatellar pain syndrome,” with a disability rating of 10%.

CI CONTENTION:  The CI requests consideration of all non-service rated conditions as well as conditions rated by the VA not adjudicated by the Service.  The CI’s complete submission is at Exhibit A.  

SCOPE OF REVIEW:  The Board’s scope of review is defined in DoDI 6040.44.  It is limited to those conditions determined by the Physical Evaluation Board (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 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 based upon a 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 PEB - 20060425	VARD - 20061228	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Left Knee RPPS…	5099-5003	10%	Left Knee Meniscal Tear…	5259	10%	20061010	
PTSD	Not Unfitting	PTSD	9411	0%	STR	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  10%	

ANALYSIS SUMMARY:  

Left Knee Condition.  According to service treatment records (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s left knee condition began in 2003 after he was injured during a road march in Iraq.  He presented to orthopedics complaining of locking and giving way of the knee that persisted after conservative treatment.  Neuroimaging demonstrated a medial meniscal tear.  He had retropatellar pain syndrome and patellar tendonitis.  He underwent surgical repair and a significant portion of the meniscus was removed.  There was no further locking or buckling but the anterior knee pain persisted, consistent with chronic RPPS and patellar tendonitis.  He had a chronic deep ache in the knee rated 6/10 that increased to 9/10 with increased activity.  It prevented prolonged standing, carrying more than 20 pounds and kneeling to fire a weapon.  

Examination showed tenderness of the patellofemoral region, infrapatellar tendon and medial patellar facet.  There was no swelling and the medial and lateral collateral ligaments were not tender.  Range of motion (ROM) of the knee was flexion to 135 degrees with a goniometer.  There was no medial or lateral instability.  Gait and stance were normal.  X-ray showed mild medial tibia subchondral sclerosis (hardening.)  At the MEB examination (recorded on DD Forms 2807 and 2808) dated October 2008, 2 months prior to separation, examination showed the CI had lateral left knee crepitus and was unable to fully flex and squat.  He was unable to perform physical training/duties without severe pain.

At the VA Compensation and Pension (C&P) examination performed 4 months after separation, the CI reported aching, sharp pain 5 times per week, lasting each time for 3 hours.  The pain may be spontaneous or occur with physical activity.  He can function with medication if there is pain.  He could stand or walk for 45 minutes before needing to rest.  His condition did not cause incapacitation.  He took medication daily and as needed for pain relief.  His military job changed to teaching because of the knee.  He was employed as a police officer and perform his activities of daily living, do housework and drive.  Examination of the left knee showed tenderness and crepitus.  Joint function was limited to an unknown degree by pain, weakness, lack of endurance with pain having the greatest functional impact.  There were surgical scars over the left medial and lateral knee, 1 cm x 1cm.  There was no evidence of instability.

The Board directed attention to its rating recommendation based on the above evidence.  The PEB rated the left knee condition 10%, coded 5099-5003 (degenerative arthritis), for pain rated as slight and constant relying upon the US Army Physical Disability Agency (USAPDA) pain policy.  The VA also rated the back condition 10% coded 5259 (cartilage, semilunar, removal, symptomatic,) based on the VA C&P examination 4 months after separation, due to symptomatic removal of the semilunar cartilage.  While there was no evidence of compensable limitation of motion, the Board agreed that the PEB’s 10% rating was supported under the 5003 coding pathway by sufficient evidence of painful motion and or crepitation (§4.59).  Absent surgical intervention, instability or abnormal boney union, alternative knee codes of 5258, 5257 and 5260 were not applicable.  All members agreed that there were no available alternative coding options which were advantageous to the CI’s current 10% 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’s adjudication for the right knee condition.

Contended PEB Condition:  Posttraumatic Stress Disorder (PTSD).  The Board’s main charge is to assess the fairness of the PEB’s determination that PTSD was not unfitting.  The psychology addendum noted the CI had sleep issues over the past 16 months.  He also had nightmares 2-3 times per week that he was back in Iraq.  He tried to stay busy and maintained a 4.0 average in an online school.  He took a sleep aid.  Mental status examination (MSE) was unremarkable.  A diagnosis of PTSD was rendered with a Global Assessment of Functioning (GAF) score of 65 (mild symptoms, impairment.)  The condition was profiled as S3 and judged to fail retention standards but neither the commander’s statement nor any other performance based evidence from the record that any of this condition significantly interfered with satisfactory duty performance.  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 fitness determination for the PTSD contended condition and so no additional disability ratings are recommended.

BOARD FINDINGS:  In the matter of the left knee retro patellar pain syndrome condition and IAW VASRD §4.71a, the Board unanimously recommends no change in the PEB adjudication.  In the matter of the contended PTSD condition, the Board unanimously recommends no change from the PEB determination as not unfitting.  There were no other conditions within the Board’s scope of review for consideration.  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 20140306, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

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 AR20160013465 (PD201401211)

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