RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2014-01052
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20061129

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E2, Motor Transport Operator, medically separated by the Informal Physical Evaluation Board for “knee pain, status post right ACL reconstruction,” with a disability rating of 10%.    

CI CONTENTION:  The CI asserts that he continues to experience chronic pain and swelling of his knee joint with limitation of motion which impacts his everyday life.  His 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 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 - 20061024	VARD - 20090504	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Knee Pain, Status Post Right ACL Reconstruction	5257	10%	Right Knee Anterior Cruciate Ligament Tear…	5260	0%	20090304	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  0%	

ANALYSIS SUMMARY:  The Board noted that the earliest VA Compensation and Pension (C&P) examination was well over 2 years after the date of separation.  DoDI 6040.44 provides for consideration of post-separation VA findings, particularly within 12 months of separation, although the Board’s recommendation is premised on the degree of disability at separation.  Therefore, in this case, the evidence from the service treatment record (STR) was assigned exclusive exam probative value (PV) with respect to the Board’s final impairment recommendation.

Right Knee Pain Condition.  The CI originally injured his right knee in October 2004 while in basic training and again in September 2005 after jumping from a vehicle.  Magnetic resonance imaging (MRI) revealed tears of the medial and lateral right meniscus as well as a complete disruption of the ACL.  Due to persistent right knee pain and frequent physical findings of instability, the CI underwent an ACL reconstruction with grafting and debridement of the meniscal tears on 22 December 2005.  An orthopedic follow-up on 18 August 2006 (8 months after surgery and 3 months prior to separation), noted the CI with persistent right knee pain and swelling with activity and that the “knee does not give way but feels weak.”  The corresponding physical examination (PE) revealed no painful motion or instability.  The CI was permanently profiled in August 2006 and referred to an MEB.  

At the narrative summary (NARSUM) examination (12 October 2006 and 6 weeks pre-separation) the CI endorsed constant daily 6/10 right knee pain which was aggravated by lifting more than 45 pounds, prolonged standing, running, or maneuvering stairs.  His pain was assessed as “moderate” and “constant.”  The PE revealed minimally decreased and painful motion.  Tests of instability were documented using a KT 2000 orthopedic arthrometer with the right knee measured at 9 millimeters of anterior translation compared to the (uninjured) left knee at 5 millimeters of translation.  There was no comment in regards to the presence of knee tenderness, muscular atrophy, or surrounding neurologic abnormality.  His diagnosis was listed as “old disruption of right ACL.”  The commander’s statement endorsed the CI’s inability to perform military duties due to his proscribed physical restrictions.  There was no VA evaluation as previously noted above.  

The Board directed its attention to its rating recommendation based on the above evidence.  The PEB assigned a 10% rating under code 5257 (knee; other impairment) subsuming all conditions of the right knee and citing a 4 millimeter (knee motion) delta as compared to the uninjured left knee.  In accordance with the Wheeless Textbook of Orthopedics the expected degree of anterior knee motion following ACL reconstruction should be less than 3 millimeters as compared to the non-surgical knee.  Clearly, in this case, the measured delta of 4 millimeters of knee motion supports an instability rating and therefore, members agreed with the PEB’s coding approach of 5257.  The Board concluded that the degree of right knee instability was best described as “slight” and is supported at 10% as adjudicated by the PEB.    

The Board then considered including an additional code of 5259 (cartilage removal) with its sole rating of 10% to the decision regarding the 5257 instability code.  All members agreed that the additional rating of 10% was supported by the CI’s surgical history of debridement of the torn menisci.  After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the Board concluded that a disability rating of 10% for the right knee instability condition was appropriately recommended in this case, but an additional code of 5259 at 10% impairment should also be applied IAW VASRD §4.71a.  

BOARD FINDINGS:  In the matter of the right knee condition and IAW VASRD §4.71a, the Board unanimously recommends no change in the PEB’s current adjudication under VASRD code 5257, but also recommends adding code 5259 for an additional 10% for a combined 20% impairment rating.  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	
Right Knee Pain, Status Post ACL Reconstruction 	5257	10%	
Right Knee Instability	5259	10%	
COMBINED	20%	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20140226, 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, AR20160005443 (PD201401052)

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