RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2014-02913
BRANCH OF SERVICE:  Army	BOARD DATE:  20150618
SEPARATION DATE:  20070608

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E-5 (Fire Support Specialist) medically separated for a knee condition.  The condition 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, status post 3 arthroscopies” as unfitting, rated 10% with application of 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 20070409	VA* - Based on Service Treatment Records (STR)	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Left Knee Pain…	5099-5003	10%	Chronic Left Knee Instability…	5257	10%	STR	
Other x 0 (Not In Scope)	Other x 6 (Not in Scope)	
RATING:  10%	RATING:  10%	
*Derived from VA Rating Decision (VARD) dated 20090107 (most proximate to date of separation [DOS]).

ANALYSIS SUMMARY:

Chronic Left Knee Pain Condition.  Treatment records evidence that the CI underwent three left knee surgeries (two arthroscopic surgeries for left knee medial meniscal debridement and one open knee surgery for autologous chondrocyte implantation for a medial femoral condyle lesion) between 2000 and 2003.  A magnetic resonance imaging study dated 17 November 2007 demonstrated a signal abnormality of the left knee medial meniscus consistent with a tear or post-surgical change.  Despite surgical and conservative management (physical therapy and anti-inflammatory/narcotic medications), the CI continued to report a 6-year history of chronic left knee pain.  At the MEB exam, the CI reported chronic left knee pain with locking.  The MEB physical examination documented decreased left knee range-of-motion (ROM), moderate crepitus, diffuse tenderness to palpation, and increase laxity with side to side stress.  The narrative summary examination documented an antalgic gait, diffuse tenderness to palpation, pain with all aspects of the examination, and pain limited knee flexion to 120 degrees.  A diagnosis of chronic left knee pain was rendered.  There was no VA Compensation and Pension examination prior to or within 12 months of separation.

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 ~3 Mo. Pre-Sep
(20070306) 	MEB ~6 Mo. Pre-Sep
(20061215) 	
Flexion (140 Normal)	85,90,94	0-125	
Extension (0 Normal)	0,0,0	#	
Comment	Pain limited motion; no instability	Pain limited motion; no instability	
§4.71a Rating	10%	10%	

The Board directed attention to its rating recommendation based on the above evidence.  The PEB adjudicated the left knee condition as unfitting and rated at 10% with cited application of the USAPDA pain policy; coded 5099-5003 (analogous to degenerative arthritis).  The VA rated the condition at 10% for slight recurrent instability and coded 5257 (knee, other impairment of).  The Board considered whether the evidence supported a higher than 10% rating for the chronic left knee pain condition.  There was no evidence of frequent episodes of “locking,” pain, and effusion into the joint; leg limitation of motion to 30 degrees of flexion or 15 degrees of extension for a 20% rating.  The Board also considered whether the left knee instability rose to the level of unfitting for an additional service disability rating.  Board members agreed that the evidence did not support unfitting left knee instability and therefore; no addition service rating could be recommended.  Considering the totality of the evidence and mindful of VASRD §4.3 (reasonable doubt), members agreed Board consensus was that a disability rating of 10% for the chronic left knee pain condition was appropriately recommended in this case.  The Board concluded therefore that this condition could not be recommended for additional disability rating.

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 chronic left knee pain condition was operant in this case and the condition was adjudicated independently of that policy by this Board.  In the matter of the chronic 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 20140530, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

SAMR-RB

06 JUL 2016

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 XXXXXXXXXX, AR20160003296 (PD201402913)

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