RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXX	CASE:  PD-2013-01117
BRANCH OF SERVICE:  Army	BOARD DATE:  20140819
Separation Date:  20020314

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty SGT/E-5 (11H1P/Heavy Anti-Armor Weapons Infantryman) medically separated for a left knee condition which could not be adequately rehabilitated to meet the physical requirements of his Military Occupational Specialty.  He was issued a permanent L4 profile, which allowed for an alternate aerobic event to satisfy physical fitness standards, and referred for a Medical Evaluation Board (MEB).  The left knee condition, characterized as “status post (s/p) left anterior cruciate ligament (ACL) and posterior cruciate ligament (PCL) reconstruction,” by the MEB was forwarded to the Physical Evaluation Board (PEB) IAW AR 40-501.  No other conditions were submitted by the MEB.  The Informal PEB adjudicated “s/p left ACL deficiency and PCL deficiency following reconstruction” as unfitting, rated 0%, citing “Rated at 0% as soldier does not meet minimal rating criteria under the VA Schedule for Rating Disabilities (VASRD), AR 635-40 or DODI 1332.39.”  The CI made no appeals and was medically separated.

CI CONTENTION:  “Grossly underrated as shown by difference in rating between Veterans Administration and Department of Defense.  Multiple injuries sustained during hostile airborne operations and continued disability exists.”

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 those conditions identified but not determined to be unfitting by the PEB when specifically requested by the CI.  The rating for the unfitting left knee condition is addressed below; no additional conditions are within the DoDI 6040.44 defined purview of the Board.  Any conditions or contention not requested in this application, or otherwise outside the Board’s defined scope of review, remain eligible for future consideration by the Board for Correction of Military Records.

RATING COMPARISON:

Service IPEB – Dated 20011205	VA - Based on Service Treatment Records (STR*)	
Condition	Code	Rating	Condition	Code	Rating	Exam	
s/p Left ACL deficiency and PCL Deficiency Following Reconstruction	5257	0%	S/P ACL and PCL Reconstruction, Left Knee with Scar	5257	10%	 STR*	
Other x0 (Not in Scope)	Other x5	STR*	
Rating:  0%	Combined:  10%	
Derived from VA Rating Decision (VARD) dated 20020903 (most proximate to date of separation [DOS])
*Service Treatment Record

ANALYSIS SUMMARY:  The Board acknowledges the impairment with which the CI’s service-connected condition continues to burden him but notes the Disability Evaluation System has neither the role nor the authority to compensate members for anticipated future severity or potential complications of conditions resulting in medical separation.  That role and authority is granted by Congress to the Department of Veterans Affairs (DVA), operating under a different set of laws.  Additionally, although the Board considers DVA evidence proximate to separation in arriving at its recommendations, DoDI 6040.44 prescribes a 12-month interval for special consideration of post-separation evidence, which is probative to the Board’s recommendations only to the extent that it reasonably reflects the disability at the time of separation.

Status Post Left ACL and PCL Deficiency Following Reconstruction Condition:  On 28 April 2001, while deployed and involved in an airborne operation, the CI sustained a multi-ligamentous injury to his left knee when his left foot became entangled in his parachute.  He was medically evacuated to Camp Bondsteel where he was evaluated and then medically evacuated to Italy for physical therapy (PT).  The examiner documented a large left knee effusion, tenderness and ecchymosis with limited flexion to 60 degrees and extension to 25 degrees with pain and calf tenderness.  The examiner diagnosed an acute PCL/medial collateral ligament (MCL) injury with a possible ACL injury and advised use of a wrap, hinged knee brace, ice elevation, crutches, pain medication, PT and magnetic resonance imaging (MRI).  The PT consult dated 4 May 2001 noted left knee pain rated 2-3/10 and at worst at 5/10, with limited range-of-motion (ROM), swelling and an antalgic gait.  On 11 May 2001, the orthopedist noted a moderate effusion and evidence of instability.  An MRI confirmed complete tears of the ACL and PCL with a Grade 2-3 MCL sprain.  The CI was medevac’d to Walter Reed Army Medical Center for extensive PT.  The CI underwent an allograft two bundle of the PCL reconstruction with bone-tendon-bone allograft and ACL reconstruction of the left knee.  The CI underwent PT post-operatively for left knee strengthening and pain reduction.  The PT clinic documented limited ROM on flexion to 120 degrees, left knee swelling, a positive valgus stress test and fair quad tone in October 2001.  The PT physical exam findings are summarized in the chart below.  Approximately 5 months prior to separation, the orthopedist documented that the CI had some left knee pain at the end of the day and left knee swelling.  The orthopedic physical exam findings are summarized in the chart below.  The MEB narrative summary (NARSUM) exam dated 16 October 2001, 5 months prior to separation, documented that the CI had limited ROM flexion to 120 degrees.  He could run only under PT guidance and was only able to engage in limited physical activities and physical training.  The MEB NARSUM physical exam findings are summarized in the chart below.  The CI was given a permanent L4 profile for PCL/ACL deficiency, s/p reconstruction with additional limitations of no running, jumping, climbing, sports or organized PT.  The commander’s statement offered no useful information.  The CI did not undergo a VA Compensation and Pension exam.

There were three goniometric ROM evaluations in evidence, with documentation of additional ratable criteria, which the Board weighed in arriving at its rating recommendation, as summarized in the chart below.

Left Knee ROM In Degrees	PT 5 Mos. Pre-Sep (20011012)	Ortho 5 Mos. Pre-Sep (20111015)	MEB 5 Mo. Pre-Sep (20011016)	
Flexion (140⁰ Normal)	120	90*	120	
Extension (0⁰ Normal)	0	0	0	
Comment	Normal strength; Pos. swelling; No instability	*With weight bearing; Normal strength; Pos. swelling; No instability	Minimal Crepitus; Motor/sensory intact	
§4.71a Rating	0%	0%	10%	

The Board directs attention to its rating recommendation based on the above evidence.  The PEB coded the s/p left ACL deficiency and PCL deficiency following reconstruction condition as 5257 (other impairment of the knee) and rated it 0% noting that the CI did not meet minimal rating criteria.  The VA used the same code and rated it 10% “slight” based on the STR.  All exams performed proximate to separation demonstrated non-compensable ROM measurements and no indication of instability as required for application of a knee specific code.  There was however, evidence of joint disease IAW §4.59, painful motion, including minimal crepitus and satisfactory evidence of painful motion in the STR.  After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt) and §4.59, 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.  As discussed above, PEB reliance on AR 635-40 and DoDI 1332.39 for rating the left knee condition was operant in this case and the condition was adjudicated independently of that policy by the Board.  In the matter of the s/p left ACL deficiency and PCL deficiency following reconstruction condition, the Board unanimously recommends a disability rating of 10%, coded 5099-5003, IAW VASRD §4.71a.  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:

UNFITTING CONDITION	VASRD CODE	RATING	
S/P Left ACL Deficiency and PCL Deficiency Following Reconstruction Condition	5099-5003	10%	
COMBINED	10%	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20130812, 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 XXXXXXXXXXXXXXXXX, AR20150003033 (PD201301117)

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:

Encl						     

CF: 
(  ) DoD PDBR
(  ) DVA