RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	    CASE:  PD-2014-00816
BRANCH OF SERVICE:  Army	SEPARATION DATE:  20051222

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E-5 (Food Service Specialist) medically separated for a left knee condition.  The condition could not be adequately rehabilitated to satisfy the physical requirements of his Military Occupational Specialty (MOS).  He was issued a permanent L3 profile and referred for a Medical Evaluation Board (MEB).  The left knee condition, characterized as “left knee moderate osteoarthritis with associated pain,” was forwarded to the Physical Evaluation Board (PEB) IAW AR 40-501.  No other conditions were submitted by the MEB.  The Informal PEB (IPEB) adjudicated “osteoarthritis, left knee, status post ACL reconstruction,” as unfitting, rated 0%.  The CI appealed to the Formal PEB (FPEB) and submitted a written appeal.  The appeal was reviewed by the US Army Physical Disability Agency (USAPDA) which affirmed the IPEB findings and rating.  

CI CONTENTION:  The applicant makes no specific contention in his application.  His 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/Naval 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:  

FPEB - Dated 20051108	VA* - (~3 Mos. Pre-Separation)  	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Osteoarthritis, Left Knee	5003	0%	S/P ACL Repair w/DJD	5260	10%	20050916	
Other Conditions x 0 (Not In Scope)	Other x 1 	
RATING:  0%	RATING:  10%	
*Derived from VA Rating Decision (VARD) dated 20060404 (most proximate to date of separation [DOS]).  

ANALYSIS SUMMARY:  

Osteoarthritis (OA), Left Knee Condition.  The record shows that the CI was first evaluated for his left knee pain on 23 July 2001 when he reported a 2-month history of pain since a road march.  His knee was stable and meniscal (cartilage cushions inside the knee) signs were absent.  He was treated conservatively with medications, immobilization (crutches), and duty restrictions.  The CI was seen periodically over the next few years.  On 26 April 2004, he was found to have indications of a tear of the anterior cruciate ligament (ACL, a ligament provided internal stability to the knee) and on 3 May 2004 an MRI revealed a complete tear of the ACL as well as tears of the medial meniscus (MMT) and lateral meniscus (LMT).  The ACL and MMT were repaired surgically on 13 September 2004; the lateral meniscus was found to be intact at surgery.  He was referred to physical therapy (PT) for rehabilitation.  His examination showed a good repair of the ACL and the MMT, but he had persistent pain.  On 23 May 2005, he had a second arthroscopy of the knee with debridement of cartilage and removal of some of the hardware placed for the ACL repair.  His symptoms did not improve and he was referred for an MEB.  The MEB examination was on 22 July 2005, 2 months after surgery.  Motion and weight bearing were painful.  The range-of-motion (ROM) was reduced to less than 50%.  

The narrative summary (NARSUM) was dated 12 August 2005, 4 months prior to separation.  On examination, the incision was well healed.  He had a mild effusion and was tender along the inside of the knee and at the site of the ACL graft insertion into the tibia (shin bone).  Flexion was limited to 110 degrees.  No comment was made on painful motion.  The knee was stable and provocative signs for meniscal irritation were not recorded.  His strength was reduced at 4+/5, but the action officer noted this is not unexpected given the recent surgery less than 3 months earlier.  

At the VA Compensation and Pension (C&P) examination performed on 16 September 2005, 3 months before separation, the CI reported ongoing pain and subjective instability.  He was able to push a lawn mower, but was unable to climb stairs.  His gait was normal and no assistive device was in use.  The ROM was reduced and painful as charted below.  The joint was stable and provocative tests for meniscal irritation were negative.  An x-ray was consistent with the prior surgeries and demonstrated severe narrowing in the area where the medial meniscus had been repaired.  An orthopedic addendum was dated 31 October 2005.  It noted that the CI reported increased pain if he stood over 20 minutes or walked over 50 yards.  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.

Left Knee ROM
(Degrees)	MEB ~4 Mo. Pre-Sep	VA C&P ~3 Mo. Pre-Sep	
Flexion (140 Normal)	110	100	
Extension (0 Normal)	0	0	
Comment	Painful motion noted in activities	Painful motion	
§4.71a Rating	10%	10%	

The Board directed attention to its rating recommendation based on the above evidence.  The PEB rated the knee condition at 0%, coded 5003 (degenerative arthritis).  The VA rated the knee at 10%, coded 5260 (limitation of flexion).  The Board noted that a 10% rating is supported by the presence of painful motion reported at both examinations.  Absent instability or a history of frequent “locking, pain, and effusion”, the Board found no route to a rating higher than 10%.  The code 5259 (removal of a meniscus) provides no rating advantage to the CI over 5003 or 5260.  However, it is a more accurate description of the pathology and is recommended for use.  
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 left knee pain condition, coded 5259.  
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.  As discussed above, PEB reliance on AR 635-40 for rating the left knee osteoarthritis condition was operant in this case and the condition was adjudicated independently of that regulation by this Board.  In the matter of the left knee osteoarthritis condition, the Board unanimously recommends a disability rating of 10%, coded 5259 IAW VASRD §4.71a.  There were no other conditions within the Board’s scope of review for consideration.  

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

CONDITION	VASRD CODE	RATING	
Osteoarthritis, Left Knee	5259	10%	
RATING	10%	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 201400816, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

SAMR-RB										

MEMORANDUM FOR Commander

SUBJECT:  Department of Defense Physical Disability Board of Review Recommendation for XXXXXXXXXXXXXXXXXX, AR20160004392 (PD201400816)

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