RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXXX	CASE:  PD-2014-00646
BRANCH OF SERVICE:  Army	SEPARATION DATE:  20051022

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E5, Military Police, medically separated for “chronic pain left knee secondary to patellar instability” with a disability rating of 0%.

CI CONTENTION:  The applicant contends that his left knee was rated higher by the VA than the Army.  He also mentions that his PTSD wasn’t listed, but was evaluated. 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 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:

SERVICE PEB - 20050718	VARD - 20060510	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Pain Left Knee	5257	0%	Left Knee Instability	5257	20%	20060310	
COMBINED RATING:  0%	COMBINED RATING OF ALL VA CONDITIONS:  60%	

ANALYSIS SUMMARY:

Chronic Pain Left Knee.  According to the service treatment record (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), this CI had left knee surgery in February 2004, for a lateral release and medial patellofemoral ligament (PFL) repair.  The CI reinjured his left knee and underwent a second surgery in December 2004 for reconstruction of the medial PFL.  The CI reinjured his left knee and underwent a third surgery in April 2005 for revision of the medial PFL.  Following the third surgery, he continued to have problems with his left knee and an MEB was initiated.  The MEB forwarded “left knee patellar instability” for PEB adjudication.  At the May 2005 NARSUM examination, 5 months before separation, the examiner noted the CI was unable to run, jump, or stand greater than 20 minutes.  Physical examination of the left knee showed no effusion or warmth. There was an 8-10 mm area of dehiscence (wound rupture) in the anterior incision with no erythema, discharge or tenderness. The remainder of the surgical incisions were well-healed and non-tender. There was mild tenderness to palpation over the medial and lateral joint lines, as well as the medial border of the patella.   His active range of motion (ROM) was “full.”  Motor and sensation were intact.  Tests for tibio-femoral joint instability were negative.

During the June 2005 MEB examination (DD Form 2808, Report of Medical Examination), 4 months before separation, the CI reported left knee swelling with inability to walk correctly.  He wore a knee brace for strenuous activities and sports.  The physical examination showed reduced ROM (flexion 95 degrees (normal 140)) with painful motion and moderate tenderness and swelling.

At the VA Compensation and Pension (C&P) examination in March 2006, 5 months after separation, the CI reported performing well as a custodian; however, during work he fell down some stairs in January 2006 and reinjured his left knee (dislocated patellar).  He had pain with walking or standing and was using a cane.  Sitting and standing were limited to 30 minutes.  Walking limited to one half mile.  Lifting limited to fifty pounds. Activities of daily living were not adversely affected.  He was undergoing no specific treatment and reported feeling no instability in his left knee.  On physical examination he had full ROM with painful motion.  The knee was stable in anterior and posterior directions and Lachman's testing was negative (to check anterior cruciate ligament instability).  The examiner was unable to perform varus and valgus stress testing due to the CI’s extreme degree of discomfort.  Loss of additional functionality could not be objectively determined after repetitive ROM testing.

The Board directed attention to its rating recommendation based on the above evidence.  The PEB assigned a 0% rating coded 5257 (knee, other impairment of: recurrent subluxation or lateral instability).  The VA assigned a 20% rating also coded 5257 based on the C&P examination 5 months after separation, citing moderate recurrent subluxation or lateral instability.

The Board determined there was no limitation of motion that supported a rating under the VASRD codes 5260 or 5261.  There was no history of dislocated meniscus or loose body causing frequent locking with recurrent effusions (5258), or history of surgery to remove a meniscus (5259) to support a rating under the respective codes.  There was no fracture, non-union, or malunion of the femur or tibia to support consideration under the respective codes for knee impairment related to long bone conditions (5255, 5262).  However, there was sufficient evidence of patellar instability, with recurrent patellar subluxation/dislocation (5257).  The Board majority agreed the CI’s knee impairment was best described as slight not moderate.  After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the Board recommends a disability rating of 10% for the chronic left knee pain, coded 5257.

BOARD FINDINGS:  In the matter of the chronic left knee pain condition, the Board majority recommends a disability rating of 10%, coded 5257 IAW VASRD §4.71a.  The single voter for dissent did not elect to submit a minority opinion.  There were no other conditions within the Board’s scope of review for consideration.

The Board therefore recommends that the CI’s prior determination be modified as follows, effective as of the date of the prior medical separation:

CONDITION	VASRD CODE	PERMANENT RATING	
Chronic Left Knee Pain	5257	10%	
The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20140124, 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 XXXXXXXXXXXXXXXXXXXX, AR20160010335 (PD201400646)

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 10% 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