RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2014-02906
BRANCH OF SERVICE:  Army	BOARD DATE:  20150324
SEPARATION DATE:  20040309

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E-2 (Wheeled Vehicle Repairer) medically separated for a left knee condition.  The condition could not be adequately rehabilitated to meet the physical requirements of his Military Occupational Specialty (MOS) or satisfy physical fitness standards.  He was issued a permanent L3 profile and referred for a Medical Evaluation Board (MEB).  The condition “left retropatellar pain syndrome [RPPS]” was forwarded as the sole submission to the Physical Evaluation Board (PEB) IAW AR 40-501.  The Informal PEB adjudicated “chronic left knee pain” as unfitting, rated 10%, citing application of the US Army Physical Disability Agency (USAPDA) pain policy.  The CI made no appeals and was medically separated.  

CI CONTENTION:  The CI requested that the Board review all conditions. His 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 20040128	VA* - Based on Service Treatment Records (STR)	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Left Knee Pain	5099-5003	10%	RPPS, Left Knee 	5299-5260	10%	STR	
Other MEB/PEB Conditions x 0 (Not In Scope)	Other x 0	
RATING:  10%	RATING:  10%	
*Derived from VA Rating Decision (VARD) dated 20040323 (most proximate to date of separation (DOS)).  

ANALYSIS SUMMARY:  

Left Knee.  The service treatment record (STR) documented a prior injury and arthroscopy of the left knee in November 1998, which was not noted on the military entry physical, dated 22 October 2002.  Two weeks into basic training (February 2003, 13 months prior to separation), the CI suffered a twisting injury of the same knee.  There are subsequent STR entries that documented continuing pain and activity restrictions, but full range-of-motion (ROM) and no signs of instability or impingement.  Magnetic resonance imaging (MRI) in May 2003 showed intact ligaments and menisci, and was significant only for a small bone contusion.  The pain, with subjective instability and locking, continued; and, after orthopedic consultation a repeat MRI (August 2003) was interpreted as a meniscal tear.  The CI underwent arthroscopic surgical intervention in September 2003 (6 months prior to separation); and, the operative note indicated that there was “minor damage” of sub-patellar (knee cap) cartilage (“fairly extensive area of grade I and grade II chondromalacia”), but no tear or injury to the meniscus itself and no ligament injury.  The joint was debrided and the post-operative course was uncomplicated; but, the CI continued to complain of pain with subjective locking and instability, and was ultimately referred for a MEB.  Post-operative STR entries documented measured flexion in the range of 120-130 degrees (normal 140 degrees, minimum compensable 45 degrees) and an intermittently antalgic gait (brace for comfort); but, the joint was stable to physical exam without mechanical impingement (locking), persistent effusions, or periods of incapacitation.  

The narrative summary (NARSUM) was conducted 15 January 2004 (7 weeks prior to separation); and, documented “constant” and “slight” pain interfering with prolonged standing, kneeling, and squatting.  The NARSUM physical exam documented “pain with patellar grind but no crepitus,” the absence of effusion, stability in all planes, and no signs of cartilage impingement.  Measured flexion was 135 degrees. 

A VA orthopedic note 6 weeks after separation documented the absence of effusion, instability, or mechanical impingement; and flexion to 130 degrees.  There was no temporally probative VA Compensation and Pension examination.  

The Board directed attention to its rating recommendation based on the above evidence.  The PEB’s 10% rating analogous to 5003 (degenerative arthritis) was supported by the USAPDA pain policy, but was compliant with VASRD §4.71a criteria for the ROM and ratable findings in evidence.  The VA’s 10% rating analogous to 5260 (limitation of flexion) was based on service evidence and conceded painful motion for the minimum compensable rating.  There is no evidence for compensable ROM impairment, frequent effusions, or locking which would support a rating higher than 10% under any applicable code; and, no grounds for additional rating of instability.  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 of 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.  As discussed above, PEB reliance on the USAPDA pain policy for rating was operant in this case and the condition was adjudicated independently of that policy by the Board.  In the matter of the 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 20140617, 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, AR20150018872 (PD201402906)

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