RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXXXX	CASE:  PD-2014-02989
BRANCH OF SERVICE:  Army	SEPARATION DATE:  20030912

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was a Guard E4, Armor Crewman, medically separated for “chronic left knee pain,” with a disability rating of 10%.

CI CONTENTION:  The CI requested that the Board review all of his conditions.  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 on 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 - 20030714	VARD - 20031231	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Pain, Left Knee	5099-5003	10%	Status Post Arthroscopy, Left Knee	5260	0%	20031110	
Chronic Anxiety/Depression	Not Unfitting	No VA Placement*	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  0%	
*Later panic disorder, anxiety disorder…status post left knee arthroscopy rated 50% effective 20030303

ANALYSIS SUMMARY:

Left Knee.  According to service treatment records and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI injured his left knee in a road march approximately 4 years prior to referral for MEB.  A left knee diagnostic imaging study showed a lateral meniscus tear.  On 19 September 2002, the CI underwent left knee arthroscopy which revealed a lateral and meniscal tear.  The orthopedic surgeon performed partial lateral and medial meniscectomies.  A left knee X-ray showed no fracture, dislocation, or soft tissue abnormality.  Six weeks postoperatively, physical therapy documented active range of motion (ROM) of flexion of 140 (normal 140) and extension of 0 (normal 0) degrees.  At the 3 March 2003 NARSUM, 6 months before separation, the CI complained of continued left knee pain following arthroscopic surgery.  Pain was exacerbated by prolonged standing, marching, running, and jumping.  The physical examination documented the CI walked with a cane.  The left knee examination revealed no joint swelling or tenderness.  Active ROM was flexion of 130 and extension of 0 degrees.  The diagnosis listed chronic left knee pain, status post arthroscopic surgery for partial medial and lateral meniscal tear.  Left knee ROM was measured by physical therapy with a goniometer for the MEB.  Active ROM was flexion of 130 and extension of 0 degrees.  At an orthopedic surgery follow-up, the CI complained of left knee pain without significant resolve.  The left knee examination revealed pain with deep palpation of the posterior knee and diffuse lateral joint line tenderness.  The patella tracked appropriately with no significant grind.  There was no swelling, erythema (redness), warmth, edema (excess tissue fluid swelling), or effusion (fluid collection).  There was no ligamentous laxity and the McMurray (assesses menisci) test was negative.  The ROM was full.  The assessment listed status post left knee arthroscopy and debridement of meniscal tears.  A left knee X-ray was normal.

At the VA Compensation and Pension (C&P) examination, 2 months after separation, the CI complained of daily 8/10 left knee pain with associated weakness, stiffness, swelling, instability, giving way, fatigability, and lack of endurance.  He denied heat, redness, locking, dislocation, subluxation, or flare-ups.  The CI reported using a cane and soft knee brace but denied using of a crutch or corrective shoes.  Pain was exacerbated by prolonged standing and walking.  The physical examination documented a left-sided limp.  The left knee examination revealed well-healed arthroscopy scars and slight tenderness.  There was no ankylosis (joint stiffening or immobility), swelling, redness, heat, edema, effusion, instability, or weakness.  There was no ligamentous laxity and the medial and lateral meniscus test was negative.  Active ROM was flexion of 140 and extension of 0 degrees.  There was no abnormal movement, guarding of movement, or pain with ROM.  Repetitive ROM was not additionally limited by pain, fatigue, weakness, or lack of endurance.  The examiner recounted the findings of the X-rays.  The diagnosis listed status post left knee arthroscopy with no loss of function.  At a 25 February 2004 orthopedic surgery evaluation, 5 months after separation, the CI complained he had lost some left knee ROM and was concerned because his left quadriceps was fairly weak.  The examiner documented “He apparently had an evaluation done at the VAMC and they recorded a normal ROM.  He states that he cannot bend his knee normally.”  The left lower extremity examination revealed some quadriceps atrophy with no effusion.  Active ROM was flexion of 95 and extension lacked 5 degrees.

The Board directed attention to its rating recommendation based on the above evidence.  The PEB rated the left knee condition at 10%, analogously code 5003 (degenerative arthritis) citing chronic left knee pain, status post arthroscopic treatment of lateral meniscus tear, and rated as slight/constant pain.  The VA rated the left knee condition at 0%, coded 5260 (leg, limitation of flexion) based on the VA C&P examination 2 months after separation, citing ROM and no functional loss due to pain, fatigability, weakness, or lack of endurance.  The Board agreed the ROM values in the examinations proximate to separation did not support a minimum rating for knee flexion (5260) or extension (5261) codes.  While the CI underwent partial lateral and medial meniscectomies, there was no dislocated meniscus (5258) or symptomatic removed meniscus (5259) for consideration under these respective codes.  There was no knee ankylosis (5256), knee recurrent subluxation/lateral instability (5257), tibia and fibula nonunion/malunion (5262), or genu recurvatum (5263) for consideration under these respective codes.  The Board agreed a 10% rating was supported based on VASRD §4.40 (functional loss) or §4.59 (painful motion).  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 for the left knee condition.

Contended PEB Condition:  Chronic Anxiety/Depression.  The Board’s main charge is to assess the fairness of the PEB’s determination that the condition was not unfitting.  The contended condition was not profiled or implicated in the commander’s statement and was not judged to fail retention standards.  The contended condition was reviewed and considered by the Board.  There was no performance based evidence from the record that 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 contended condition and so no additional disability rating is  recommended.

BOARD FINDINGS:  In the matter of the left knee condition and IAW VASRD §4.71a, the Board unanimously recommends no change in the PEB adjudication.  In the matter of the contended chronic anxiety/depression 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 20140428, 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 AR20160013888 (PD201402989)

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