RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2014-00592
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20060507

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E-6, Multichannel Transmission Systems Operator-Maintainer, medically separated for “chronic left knee pain,” with a disability rating of 10%.  

CI CONTENTION:  The applicant makes no specific contention in the application.  The applicant’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 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:  

PEB - 20060207	VARD - 20060522	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Left Knee Pain	5259	10%	Left Knee Instability	5257	10%	20060316	
			Residuals of Left Knee Meniscal Tear, Postoperative	5259	10%	20060316	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  60%	

ANALYSIS SUMMARY:  

Chronic Left Knee Pain.  According to service treatment records and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI underwent left knee arthroscopic surgery in 1996 which included meniscal debridement to help with locking symptoms.  Subsequently, the CI reported occasional on and off knee pain that has worsened with activity and described persistent locking and instability symptoms.  Radiographic studies in December 2005 showed no evidence of arthritic or inflammatory changes.  

Conservative treatment did not result in improvement sufficient to allow unrestricted duty and further surgical intervention was declined.  The MEB forwarded “left chronic knee pain” for PEB adjudication.  

The MEB NARSUM dated 16 December 2005, 5 months before separation, noted the above history.  At that exam, the CI reported persistent left knee locking and instability symptoms with chronic knee pain.  The MEB physical noted a normal gait with tenderness to palpation on the medial lateral joint line and no effusion.  Examination tests for ligamentous varus and valgus instability were negative.  Anterior and posterior drawer tests were negative, but there was a (positive) 1A Lachman.  There was pain with McMurray (meniscal testing) and minimal patella crepitus with range-of-motion (ROM) testing.  ROM was mildly limited in flexion to 130 degrees (normal 140 degrees) and normal extension.  

At the VA Compensation and Pension (C&P) examination in March 2006, performed 2 months before separation, the CI reported left knee pain, laxity, locking, snapping and crepitus and that he was unable to run due to his knee problems.  There were flares with activity.  Physical examination demonstrated a normal gait.  Knee exam was negative for tenderness or effusion, but had “manifestation of pain and stiffness.”  There were negative McMurray’s test, Lachman’s test and drawer signs.  The examiner stated there was mild laxity on the left knee.  ROM was painful with flexion of 115 degrees (normal 140) and extension of -5 degrees (normal 0).  The examiner estimated there would be additional functional loss with lack of endurance due to pain with repetitive use.  

The Board directed attention to its rating recommendation based on the above evidence.  The PEB assigned a 10% rating under the 5259 code (cartilage, semilunar, removal of symptomatic), citing post-meniscectomy symptoms.  The VA assigned a 10% rating using the 5257 code (knee, other impairment of: recurrent subluxation or lateral instability) and a 10% rating using the 5259 code (cartilage, semilunar, removal of, symptomatic) based on the VA C&P examination 2 months before separation, citing mild instability and evidence of functional loss due to pain and status-post removal of the semilunar cartilage.  

The persistence of pain symptoms after meniscal surgery warranted a 10% rating under the 5259 code (cartilage, semilunar, removal of symptomatic) as adjudicated by the PEB and VA.  Meniscal coding includes consideration of painful motion.  It was agreed that a 20% meniscal rating under the 5258 code was not supported as frequent locking due to dislocated semilunar cartilage was not present.  

However, Board members concluded that, given the symptoms and signs of slight instability in this case, dual coding was appropriate.  In deliberating a rating under the 5257 code (knee, other impairment of; recurrent subluxation or lateral instability), the Board considered the CI’s symptoms of instability, positive Lachman’s at the MEB examination and mild instability at the VA examination indicating instability that was no more than mild.  The Board agreed that this evidence most accurately described “slight” instability under the 5257 code.  

After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the Board recommends a separation rating of 10% for symptoms including painful motion and locking following cartilage surgery, coded 5099-5259, and 10% for knee instability, coded 5257, for a combined rating of 20% for the left knee condition.  

BOARD FINDINGS:  In the matter of the left knee condition, the Board unanimously recommends a disability rating of 10%, coded 5099-5259, plus a disability rating of 10% coded 5257; both IAW VASRD §4.71a.  There were no other conditions within the Board’s scope of review for consideration.  The Board recommends that the CI’s prior determination be modified as follows, effective as of the date of the prior to medical separation:  

CONDITION	VASRD CODE	PERMANENT RATING	
Chronic Left Knee Pain	5099-5259	10%	
	5257	10%	
COMBINED	20%	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20140121, 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 XXXXXXXXXXXXXXXXXX, AR20160005858 (PD201400592)

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, accept the Board’s recommendation to modify the individual’s disability rating to 20% without re-characterization 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:

CF: 
(  ) DoD PDBR
(  ) DVA