RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXX	CASE:  PD-2014-00005
BRANCH OF SERVICE:  ARMY  	BOARD DATE:  20150716
SEPARATION DATE:  20060405

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E-3 (Automated Logistical Specialist) medically separated for a left knee injury.  The condition could not be adequately rehabilitated to meet the physical requirements of her Military Occupational Specialty (MOS).  She was issued a permanent L3 profile and referred for a Medical Evaluation Board (MEB).  The “left knee: anterior cruciate ligament deficiency with instability” was forwarded to the Physical Evaluation Board (PEB) IAW AR 40-501.  The MEB also identified and forwarded two other conditions (low back pain and headaches) for PEB adjudication.  The Informal PEB (IPEB) adjudicated the left knee injury as unfitting, rated 20%, with likely application of the Veterans Affairs Schedule for Rating Disabilities (VASRD).  The remaining conditions were determined to be not unfitting.  The CI made no appeals and was medically separated.  

CI CONTENTION:  The applicant makes no specific contention in her application.  Her 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 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:  

IPEB – Dated 20060128	VA* - (~6 Days Post-Separation)  	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Injury to Left Knee…	5257	20%	Chronic Strain Left Knee with Pain and Instability, Torn
Anterior Cruciate Ligament Tear	5257	10%	20060411	
Other x 2 (Not In Scope)	Other x 4 	
RATING:  20%	RATING:  20%	
*Derived from VA Rating Decision (VARD) dated 20060918 (most proximate to date of separation (DOS)).  

ANALYSIS SUMMARY:  

Left Knee Injury Condition.  The CI injured her left knee while running in November 2004.  She was treated with medications and duty restrictions without resolution.  She was then evaluated in orthopedics and found to have a torn anterior cruciate ligament (ACL) which was confirmed on MRI.  The latter also showed a possible tear of the medial meniscus (MMT), a cartilage cushion in the knee which was not demonstrated on physical examination.  Reconstructive surgery was recommended; however, the CI chose not to pursue this option due to her current living situation.  She was on the 4th floor of a building without stairs and stationed in a hilly area; her decision was considered reasonable.  The narrative summary (NARSUM) was dated 20 July 2005, 9 months prior to separation.  On examination, she had a normal gait and no effusion.  The range-of-motion (ROM) showed slightly reduced flexion at 135 degrees (140 is normal) and normal extension.  The knee showed signs of instability consistent with a torn ACL.  Signs of meniscal irritation were absent.  At the VA Compensation and Pension (C&P) examination performed 6 days after separation, the CI reported continued pain and limping at the end of the day.  She denied locking, but endorsed “giving way.”  She was noted to have a normal and antalgic gait (an antalgic gait is abnormal due to protecting the gait from pain).  The ROM was normal without further change with repetition.  Signs of meniscal irritation were absent.  Testing for ACL deficiency remained positive.  

The Board directed its attention to its rating recommendation based on the above evidence.  The PEB rated the left knee at 20%, coded 5257 (other impairment of the knee).  The VA used the same code, but rated the knee at 10% based on the C&P examination.  The Board considered the findings and found no route to a rating higher than the 20% adjudicated by the PEB.  A dual code rating is not supported as there is no compensable loss of motion.  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 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.  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 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 20131223, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

XXXXXXXXXXXXXXX
President
DoD Physical Disability Board of Review

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 XXXXXXXXXXXXXXX, AR20150013681 (PD201400005)

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:

Encl						     XXXXXXXXXXXXXXX
						     Deputy Assistant Secretary of the Army
						          (Review Boards)
						         
CF: 
(  ) DoD PDBR
(  ) DVA