RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2014-02774
BRANCH OF SERVICE:  Army	BOARD DATE:  20150414
SEPARATION DATE:  20030219

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E-4 (Network Switching Systems Operator Maintainer) medically separated for left knee pain.  The condition could not be adequately rehabilitated to meet the physical requirements of his Military Occupational Specialty (MOS) however; his physical profile authorized him to perform two alternate aerobic physical fitness test events.  He was issued a permanent L3 profile and referred for a Medical Evaluation Board (MEB).  The condition characterized as “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 “left knee pain as unfitting, rated 0%, with likely application of the Veterans Affairs Schedule for Rating Disabilities (VASRD).  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 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 20021028	VA* - (~9 yrs. Post-Separation)	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Left Knee Pain…	5099-5003	0%	Left Knee Retropatellar Pain Syndrome…	5260	10%	20111208	
Other x 0 (Not In Scope)	Other x 4 	
RATING:  0%	RATING:  40%	
*Derived from VA Rating Decision (VARD) dated 20111209 (most proximate to date of separation [DOS]).

ANALYSIS SUMMARY:

Left Knee Condition.  The CI originally experienced sudden left knee pain while participating in a long-distance run in April 2001.  Plain film X-rays were normal and a magnetic resonance image (MRI) performed in August 2001 revealed a small effusion with intact menisci.  The CI’s mainstay of treatment consisted of medication, restrictions, and physical therapy.  Serial Orthopedic follow-up evaluations continued a non-surgical approach to the CI’s long-term treatment plan.  A bone scan performed in April 2002 was normal in regards to the left knee and a repeat MRI in September 2002 revealed degenerative changes.  Secondary to persistent pain, the CI was permanently profiled in October 2002 with the diagnosis of left knee pain and a MEB was initiated.  At the narrative summary (NARSUM) examination, 4 months prior to separation, the CI reported constant left knee pain.  He endorsed the inability to run over 1/4 mile, walk over 2 miles, lift over 25 pounds, or carry a backpack without significant pain.  His physical examination (PE) revealed tenderness with grinding about the left knee cap with positive apprehension test (an indication of possible prior knee cap dislocation).  Muscle strength was good.  There was no evidence of edema, effusion, or laxity about the left knee.  Active range-of-motion of the left knee was full and there was no direct comment pertaining to painful motion.  His diagnosis was chronic left knee pain.  Although the commander’s statement did not specify a diagnosis, it clearly noted the CI’s inability to perform his MOS duties in a worldwide setting.  The VA Compensation and Pension examination was performed nearly 9 years after separation.  DoDI 6040.44 specifies a 12-month interval for special consideration for VA findings, rendering the probative value of the VA evidence in this case completely moot.  The Board therefore agreed to assign total probative value to the evidence from the MEB evaluation and or appropriate and timely documents within the service treatment record.

The Board directed attention to its rating recommendation based on the above evidence.  The PEB assigned a 0% rating under an analogous 5003 code (degenerative arthritis).  While there was no evidence of compensable limitation of motion at the NARSUM examination, the Board considered and agreed that the presence of “grinding” (a descriptive medical term often synonymous with “crepitus”) on PE was sufficient indirect evidence of painful motion IAW VASRD §4.59.  Absent instability or any degree of ankylosis, members agreed that there were no alternative joint or analogous coding options available that would benefit the CI above the painful motion criteria and its impairment level.  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.  The Board did not surmise from the record or PEB ruling in this case that any prerogatives outside the VASRD were exercised.  In the matter of the left knee condition, the Board unanimously recommends a disability rating of 10%, coded 5099-5003 IAW VASRD §4.59.  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	
Left Knee Pain 	5099-5003	10%	
RATING	10%	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20140602, 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 XXXXXXXXXXXXXXXXXX, AR20150019022 (PD201402774)

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