RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXXX	CASE:  PD-2013-01951
BRANCH OF SERVICE:  Army	BOARD DATE:  20150424
SEPARATION DATE:  20011012

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E-4 (Motor Transport Operator) medically separated for a right knee condition.  The right knee condition could not be adequately rehabilitated to meet the physical requirements of his Military Occupational Specialty.  His profile allowed for an alternate aerobic event to satisfy physical fitness standards.  He was issued a permanent L3 profile and referred for a Medical Evaluation Board (MEB).  “Right knee pain post-traumatic osteoarthrosis status post ACL reconstruction” was forwarded to the Physical Evaluation Board (PEB) IAW AR 40-501.  No other condition was submitted by the MEB.  The Informal PEB adjudicated “right knee, post-traumatic osteoarthrosis, status post ACL reconstruction” as unfitting, rated 10%, with likely application of the Veterans Affairs Schedule for Rating Disabilities (VASRD).  The CI made no appeals and was medically separated.

CI CONTENTION:  “I still get real bad headaches on frequent basis, and I had a second knee surgery at the VA hospital, I believe back in 2003 or 2004.  Right knee still give me problems.”

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 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:

Service IPEB – Dated 20010824	VA* - (~10 Mos. Post-Separation)	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Right Knee, Post-Traumatic Osteoarthrosis s/p ACL Reconstruction 	5010	10%	Right Knee, Post-Traumatic Osteoarthrosis	5259-5010	10%	20020810	
Other x 0 (Not in Scope)	Other x 5	
Rating:  10%	Combined:  40%	
*Derived from VA Rating Decision (VARD) dated 20020905 (most proximate to date of separation [DOS])

ANALYSIS SUMMARY:

Right Knee Condition.  After a remote right knee injury, the CI experienced knee instability and pain.  In February 2000, he underwent right knee anterior cruciate ligament (ACL) surgical reconstruction and partial meniscectomy (meniscal cartilage removal) in February 2000.  Knee pain persisted post-operatively, but stability improved.

The MEB DD Form 2808, Report of Medical Examination, dated 12 March 2001, approximately 7 months prior to separation, noted right knee tenderness, crepitance, and “adequate ROM (range of motion).”  Ligament testing was normal.  At the MEB narrative summary evaluation on 9 May 2001 (5 months prior to separation), the CI’s chief complaint was right knee pain.  His condition rendered heavy manual labor difficult, and he was unable to run, jump, squat or climb.  Examination showed a “trace effusion” (swelling) of the right knee.  He could walk on toes and heels.  ACL stability was intact.

The VA Compensation and Pension (C&P) exam on 10 August 2002 (10 months after separation) reported a normal gait.  There was no ligament instability.  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.

Right Knee ROM
(Degrees)	NARSUM ~5 Mos. Pre-Sep	VA C&P ~10 Mos. Post-Sep	
Flexion (140 Normal)	130	120	
Extension (0 Normal)	5	0	
Comment	+Tenderness, crepitus	+Painful motion	
§4.71a Rating	10%* (PEB 10%)	10%* (VA 10%)	
	                         *Conceding §4.40 (functional loss) or §4.59 (painful motion)

The Board directed attention to its rating recommendation based on the above evidence.  Although the service and C&P exams reported non-compensable limitation of motion, the 10% determination under the PEB’s 5010 code (arthritis due to trauma) was appropriate considering there was sufficient evidence of pain with use (§4.40; “functional loss”) and painful motion (§4.59).  A 10% rating was also supported via the 5259 code (cartilage, semilunar, removal of, symptomatic), reflected in the VA’s combined coding with 5010.  The Board considered other coding pathways to a rating higher than 10%.  Although the CI had a history of ACL instability after the initial injury, surgery corrected this problem.  Examinations confirmed ligament stability; therefore rating under code 5257 (knee, other impairment of) was not justified.  There was also no history of dislocated semilunar cartilage with frequent episodes of locking to warrant rating using coding option 5258 (dislocated semilunar cartilage).  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 chronic right knee pain 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 right 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 20131128, 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 XXXXXXXXXXXXXXXXXXXX, AR20150012487 (PD201301951)

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:

						         
CF: 
(  ) DoD PDBR
(  ) DVA