RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXX	CASE:  PD-2014-02426
BRANCH OF SERVICE:  Army	BOARD DATE:  20150116
SEPARATION DATE:  20070327

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E-3 (Fire Support Specialist) medically separated for left knee pain.  The left knee pain could not be adequately rehabilitated to meet the physical requirements of his Military Occupational Specialty or satisfy physical fitness standards.  He was issued a permanent L3 profile and referred for a Medical Evaluation Board (MEB).  The “chronic left knee pain,” was forwarded to the Physical Evaluation Board (PEB) IAW AR 40-501.  No other condition was submitted by the MEB.  The Informal PEB adjudicated “chronic left knee pain status post debridement of pathologic plica and revision plica resection” as unfitting, rated 10%, citing the US Army Physical Disability Agency (USAPDA) pain policy.  The CI made no appeals and was medically separated.

CI CONTENTION:  “Please consider all conditions.”

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 20070205	VA* - Based on Service Treatment Records (STR)	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Left Knee Pain	5099-5003	10%	Residuals of Left Knee Injury	5260	0%	STR	
Other x 0 (Not In Scope)	Other x 4	
RATING:  10%	RATING:  0%	
*Derived from VA Rating Decision (VARD) dated 20080225 (most proximate to date of separation (DOS))

ANALYSIS SUMMARY:

Left Knee Pain.  In October 2005, this CI injured his left knee while doing land navigation.  He jumped over a ditch, and his foot landed in a hole.  He had arthroscopic surgery on his left knee twice.  However, the knee pain persisted and MEB was initiated.  The MEB narrative summary was dictated on 9 November 2006.  The CI reported that he was unable to climb stairs or ladders.  Physical examination of the left knee revealed tenderness to palpation in the medial joint space region, and the medial femoral condyle.  There was no patellar grind or patellar apprehension.  There was no varus/valgus laxity, or cruciate ligament instability.  McMurray’s sign was negative.  The left leg was neurovascularly intact, and gait was minimally antalgic.  Left knee range-of-motion was 0-120 degrees.  The examiner’s diagnosis was:  chronic left knee pain.  The CI was medically separated from service in March 2007.  He was scheduled for a VA Compensation and Pension exam, but he failed to appear for that evaluation.  The VA assigned an initial rating of 0% for the left knee, based on evidence in the service treatment record (STR).

The Board directed attention to its rating recommendation based on the above evidence. The Board determined that the left knee condition was essentially non-compensable based on the VA Schedule for Rating Disabilities (VASRD) §4.71a codes for loss of knee motion (5260 and 5261).  However; IAW VASRD §4.40, §4.45, and §4.59, when part of the musculoskeletal system becomes painful on use, it must be regarded as seriously disabled.  A 10% rating is warranted when there is satisfactory evidence of functional limitation due to painful motion of a major joint.  There was no path to a higher rating for the left knee since there was insufficient evidence of a significantly disabling knee abnormality that would justify a higher rating.  After due deliberation, the Board determined that a disability rating of 10% was appropriate.  Considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the Board found insufficient cause to recommend a change in the PEB adjudication for the chronic unfitting left knee pain.

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 noted above, PEB reliance on the USAPDA pain policy 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 and IAW VASRD §4.40, §4.45, and §4.59, 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 20140511, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

				
XXXXXXXXXXXXXXX
President
DoD Physical Disability Board of Review

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 XXXXXXXXXXXXXXX, AR20150010605 (PD201402426)

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:

Encl			     XXXXXXXXXXXXXXX
			     Deputy Assistant Secretary of the Army
			          (Review Boards)
						         
CF: 
(  ) DoD PDBR
(  ) DVA