RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2014-01223
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20081028

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E-1, Basic Trainee, medically separated for left knee pain, with a disability rating of 10%. 

CI CONTENTION:  His condition continues to worsen and negatively impacts his daily activities.  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 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 - 20081008	VARD - 20090529	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Left Knee, Other Impairment of…	5257	10%	Left Knee Anterior Cruciate Ligament Reconstruction	5299-5257	Not Service Connected	STR	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  None	

ANALYSIS SUMMARY:  

Left Knee Impairment.  According to service treatment records (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s left knee condition began in July 2008 after a wall locker dropped against his left knee.  The initial examination demonstrated  crutch ambulation, a marked left limp, a fixed flexion deformity, and a Grade II Lachman’s (the knee moves forward 5-10 mm without an end point/ instability testing).  The NARSUM physical examination dated 13 August 2008, 2 months prior to separation showed a left knee effusion, mild tenderness to palpation effusion, and a Grade I Lachman’s (0-5 mm of anterior displacement, sometimes with an end point).  The MEB examiner referenced radiographic evaluation which demonstrated left knee degenerative joint, evidence of a prior anterior cruciate ligament (ACL) repair, ACL graft tear, and a medical meniscus tear.  The examiner noted the surgery was recommended, but that the CI opted to have it performed “where he has health care.”  The CI did not report for a VA Compensation and Pension examination.

The Board directed its attention to its rating recommendation based on the above evidence.  The PEB rated the left knee condition at 10%; coded 5257 (Knee other, impairment of, slight) citing existed prior to service undetermined and the presumption of service aggravation not overcome.  The VA did not service connect the left knee condition.   The examinations proximate to separation demonstrated the presence of ligamentous instability or laxity (5257) for a 10% rating as adjudicated by the PEB.  There was no limitation of motion which attained a minimum rating under the diagnostic codes for limitation of flexion or extension (5260, 5261).  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).  There was evidence of painful motion with functional loss supporting an additional 10% rating (based on §4.59, §4.40 and §4.45).  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 instability and 10% for the left knee painful motion condition.  

BOARD FINDINGS:  In the matter of the left knee condition, the Board unanimously recommends a disability rating of 10%, coded 5099-5003 and10% for instability, coded 5257,  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 his prior medical separation:  

CONDITION	VASRD CODE	RATING	
Left Knee Instability 	5257	10%	
Left Knee Painful Motion	5099-5003	10%	
RATING	20%	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20140309, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

SAMR-RB

13 JUL 2016

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, AR20160005845 (PD201401223)

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