RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXXX	CASE:  PD-2014-01779
BRANCH OF SERVICE:  Army	SEPARATION DATE:  20040718

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty, E5, Wheel Vehicle Mechanic, medically separated for “post-traumatic osteoarthritis, left knee” with a disability rating of 10%.

CI CONTENTION:  The CI contends for his unfitting left knee and a number of conditions not identified by either the MEB or PEB.  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 - 20040409	VARD - 20041118	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Post-Traumatic Osteoarthritis, Left Knee	5003	10%	Left Knee Sprain w/Degenerative Arthritis and Osgood-Schlatter Disease, S/P ACL Repair and Baker’s Cyst	5010-5260	10%	20040730	
			Scar, Left Knee …	7805	0%	20040730	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  20%	

ANALYSIS SUMMARY:

Post-Traumatic Osteoarthritis, Left Knee.  According to service treatment records and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI underwent left knee surgery in October 2002 for a torn anterior cruciate ligament (ACL).  Despite treatment, the left 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 “posttraumatic osteoarthritis with chronic knee pain S/P ACL reconstruction” for PEB adjudication.
The NARSUM, written in March 2004, 4 months prior to separation, indicated the CI complained of continued pain and giving way of the knee.  Physical examinaiton notes are outlined in the chart below.

At the VA Compensation and Pension (C&P) examination in July 2004, performed 2 weeks after separation, the CI reported continued pain and occasional swelling with prolonged standing, walking or running, and occasional instability.  Physical exam showed normal gait and posture, no evidence of pain on motion, effusion, instability, or tenderness.  There was no evidence of swelling or inflammation, and no locking.

The range of motion (ROM) examinations 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)	PT ~6 Mos. Pre-Sep	MEB ~4 Mos. Pre-Sep	VA C&P ~2 Weeks Post-Sep	
Flexion (140 Normal)	140	137	135	
Extension (0 Normal)	-5	0	0	
Comment	Negative Lachman and McMurray’s	Moderate effusion; 1A Lachman’s; no pivot or anterior drawer; McMurray’s elicited pain; no crepitance; positive patellar compression; tenderness to palpation	Stable joint with negative McMurray’s and Lachman’s tests	
§4.71a Rating	10%	10%	10%	

The Board directed attention to its rating recommendation based on the above evidence.  The PEB assigned a 10% rating under the 5003 code (arthritis, degenerative).  The VA also assigned a 10% rating using an analogous 5010-5260 code (arthritis, due to trauma; and leg, limitation of flexion) based on the VA C&P examination 2 weeks after separation, citing functional loss due to pain.

The Board deliberated on the probative value of the examinations in evidence.  The VA examination was closest to separation and was adjudged to have the highest probative value for rating at separation.  The VA’s finding of no left knee instability (NARSUM’s 1A Lachman’s may indicate slight laxity) aligned with the disability picture in remainder of the record, both prior to the NARSUM and after the VA examination.

There was no limitation of motion which supported a rating under the diagnostic codes for limitation of flexion or extension (5260, 5261).  However, there was evidence of painful motion with functional loss supporting a 10% rating (based on §4.59, §4.40 and §4.45) as adjudicated by the PEB.  The preponderance of 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 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).  Any disability from the scar was considered under the above rating.  There is therefore no VASRD §4.71a route to a rating higher than the 10% adjudicated by the PEB under any applicable code, and no grounds for additional rating based on the presence of instability.

After due deliberation, and in consideration of all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the Board concluded that there was insufficient cause to recommend a change in the PEB adjudication for the left knee condition.
BOARD FINDINGS:  In the matter of the left knee condition and IAW VASRD §4.71a, the Board unanimously recommends no change in the PEB adjudication.  There were no other conditions within the Board’s scope of review for consideration.

The Board, therefore, recommends that there be no re-characterization of the CI’s disability and separation determination.

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20140421, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

SAMR-RB

28 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 XXXXXXXXXXXXXXXXXXXX, AR20160007321 (PD201401779)

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,
I accept the Board's recommendation and hereby deny the individual's application.
This decision is final. The individual concerned, counsel (if any), and any Members of
Congress who have shown interest in this application have been notified of this decision
by mail.

BY ORDER OF THE SECRETARY OF THE ARMY:

Enclosure

CF:
( ) DoD PDBR
( ) DVA