RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2014-00658
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20050207

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty, E4, Health Care Specialist, medically separated for “right knee pain,” with a disability rating of 0%.

CI CONTENTION:  The CI contends for his unfitting knee.  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 - 20041202	VARD - 20051208	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Right Knee Pain	5099-5003	0%	Residuals of Right Knee Injury, S/P ACL Reconstruction and Partial Meniscectomy	5261-5024	10%	20050715	
COMBINED RATING:  0%	COMBINED RATING OF ALL VA CONDITIONS:  10%	

ANALYSIS SUMMARY:  

Right Knee Pain.  According to service treatment records and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI underwent right knee surgery in January 2004 for torn anterior cruciate ligament (ACL) and right torn medial meniscus.  Despite treatment, the right knee condition could not be adequately rehabilitated to meet the physical requirements of the CI’s military specialty and the CI was referred for a MEB.  The MEB forwarded “right knee pain status post ligament sprain and lateral meniscal repair” for PEB adjudication.

At an orthopedic visit in June 2004, 5 months post-surgery, the CI reported mild knee pain with no effusion and no complaints of locking or instability.  Physical exam noted full motion, stability to varus and valgus stress testing, a firm endpoint Lachman exam, a negative posterior drawer, no effusion, and mild tenderness over the donor site about the patellar tendon.  At the MEB examination (recorded on DD Forms 2807 and 2808) dated August 2004, 6 months prior to separation, the CI reported knee pain.  Physical exam showed no effusion, negative Drawer and Lachman tests, no crepitus, and a tender patellar tendon.  The NARSUM, written in October 2004, 4 months prior to separation, indicated the CI reported pain in his right knee when he stood for long periods of time or walked excessively.  Physical exam noted tenderness over the patellar tendon, no discomfort with varus and valgus stress, a negative Lachman’s test, and no effusion.  The CI was able to walk on heels and toes and had normal strength.  Range of motion (ROM) was grossly normal.  

At the VA Compensation and Pension (C&P) examination in July 2005, performed 5 months after separation, the CI reported continued pain, stiffness and dysmobility with occasional swelling.  Physical exam showed normal posture and gait, tenderness, without swelling, redness, warmth, ankylosis and negative Drawer sign (no instability).  There was some crepitus with repetitive movement

The Board directed attention to its rating recommendation based on the above evidence.  The PEB assigned a 0% rating under an analogous code 5099-5003 (arthritis, degenerative), citing ROM of 0-138 degrees of passive measurement and radiographs consistent with previous ACL repair.  The VA assigned a 10% rating using an analogous code 5261-5024 (leg, limitation of extension of and tenosynovitis) based on the VA C&P examination 5 months after separation, citing the increase in painful motion and crepitus following repetition.

There was no limitation of flexion or extension that supported a rating under the VASRD diagnostic codes for limitation of motion (5260 or 5261).  The examinations proximate to separation did not demonstrate the presence of ligamentous instability or laxity (5257), and there was no history of dislocated meniscus or loose body causing frequent locking with recurrent effusions (5258) to support a rating under these 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 evidence of painful motion with functional loss supporting a 10% rating (based on §4.59, §4.40 and §4.45).  The analogous code 5259 (cartilage, semilunar, removal of, symptomatic) was also applicable in this case given the CI’s history of meniscal surgery, and provided an alternate route to a 10% rating.  In considering support for a higher rating, the Board noted the dominant symptom was clearly pain; and that all tests for instability were negative, and the NARSUM examiner was silent regarding any instability symptoms.  The Board therefore concluded that there was insufficient evidence of ligament instability to support dual coding under 5257 in addition to 5003.  After due deliberation, and in consideration of all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the Board recommends a disability rating of 10% for the right knee condition, coded 5009-5003.

BOARD FINDINGS:  In the matter of the right knee condition, the Board unanimously recommends a disability rating of 10%, coded 5009-5003 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 medical separation:

CONDITION	VASRD CODE	PERMANENT RATING	
Right Knee Pain	5099-5003	10%	
COMBINED	10%	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20131130, 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, AR20160007258 (PD201400658)

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