RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXXX	CASE:  PD-2014-02254
BRANCH OF SERVICE:  Army	BOARD DATE:  20150304
SEPARATION DATE:  20050428

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E-4 (Ground Surveillance Systems Operator) medically separated for left knee pain.  The condition could not be adequately rehabilitated to meet the physical requirements of his Military Occupational Specialty or satisfy physical fitness standards, but he was authorized to perform an alternate physical fitness test (per PROFILE).  He was issued a permanent L3 profile and referred for a Medical Evaluation Board (MEB).  The condition, characterized as “chronic left knee pain status post ACL repair and chondromalacia of the lateral femoral condyle…” was forwarded to the Physical Evaluation Board (PEB) IAW AR 40-501.  No other condition was submitted by the MEB.  The Informal PEB adjudicated his knee condition as unfitting and rated it at 10% with likely application of Veterans Affairs Schedule for Rating Disabilities (VASRD).  The CI made no appeals and was medically separated.

CI CONTENTION:  “Please consider all conditions.”

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:

 IPEB – Dated 20050210	VA* - (~14 Mos. Post-Separation)	
Condition	Code	Rating		Code	Rating	Exam	
Chronic Left Knee Pain…	5099-5003	10%	…Torn Lateral Meniscus, Left Knee	5257	10%	20050722	
Other x 0 (Not In Scope)	Other x 7	
RATING:  10%	RATING:  20%	
*Derived from VA Rating Decision (VARD) dated 20060616 (most proximate to date of separation [DOS]).

ANALYSIS SUMMARY:  The Board noted that there are no service treatment records in the available records.  Member consensus was that the available records, which include the MEB narrative summary (NARSUM), MEB and PEB documents, the initial VA Compensation and Pension (C&P) examination and VARD, and the later 2008 VA Decision Review Officer Decision provide sufficient evidence upon which to base its rating recommendation for the left knee condition at the time of separation.

Left Knee Condition.  The NARSUM notes that the CI injured his left knee in 2002 while playing basketball.  A magnetic resonance imaging (MRI) showed tears of the anterior cruciate ligament (ACL) and lateral meniscus.  The CI had surgery for ACL and lateral meniscus repair on 19 September 2002.  After surgery, the CI participated in physical therapy but was unable to return to running or walking for long distances.  A repeat MRI in September 2003 reportedly showed chondromalacia of the knee and patella.

At the MEB examination on 19 January 2005, 3 months prior to separation, the CI reported chronic left knee pain.  The MEB physical exam noted knee range-of-motion (ROM) of extension –flexion 0 degrees -120 degrees (normal 0 degrees -140 degrees).  There was medial joint line tenderness with a mild effusion.  The examiner noted the knee was stable to anterior, posterior and medial, lateral stress.

At the VA C&P examination on 22 July 2005, 14 months after separation, the CI reported that the knee was constantly “uncomfortable” and frequently gave out, and he occasionally used an elastic knee support.  He reported no medical treatment for the knee since his separation from the military.  The VA examiner noted that service documents indicated “what appeared to be postoperative ACL insufficiency” and evidence of instability (anterior) in follow-up notes after the surgery.  On exam there was slight swelling of the left knee with tenderness of the joint line and ROM of 0 degrees -120 degrees with three repetitions, without evidence of instability, but the examiner noted that stability testing was limited by pain.

VA vocational rehabilitation (rehab) records in 2008 the CI listed impairment due to his knee as “can’t stand for more than an hour, can’t lift extensive amounts of weight” and noted “can’t run for long periods of time” and use of a knee brace as needed.  The rehab records also indicated that after separation the CI was employed as a security guard for 2 years, was interested in taking the firefighter’s exam, and worked in light construction.

The Board directed attention to its rating recommendation based on the above evidence.  The PEB rated the left knee condition 10%, coded 5099-5003 (analogous to degenerative arthritis) and the VA rated it 10%, coded 5257 (other knee impairment).  The CI appealed the VARD and a Decision Review Officer Decision on 31 July 2008 reconfirmed the 10% rating.  The Board agreed that the evidence in record supports a 10% rating IAW §4.71a with multiple codes-5003, 5260 (limited leg flexion) or 5261 (limited leg extension) IAW §4.59 (Painful motion), or 5259 for symptomatic semilunar cartilage, but does not achieve a 20% rating based on limitation of ROM alone, two more joints with evidence of degenerative arthritis, or semilunar cartilage injury with frequent “locking,” pain, and effusion into the joint.  The Board also considered if there was evidence of instability to provide for dual rating based on separate ratings for instability and limitation of motion.  However, although the CI reported that his knee frequently “gave out” at the C&P exam, there was no instability or laxity noted at the MEB or C&P exams and after separation rehab records indicated that the CI had participated in and was interested in pursuing physically active jobs since separation despite the knee condition.  Members agreed that based on the evidence in record application of dual rating of the knee was not indicated in this case and the Board concluded that there was no path to a higher evaluation than 10%.  After due deliberation, considering 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 right knee condition.

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.  The Board did not surmise from the record or PEB ruling in this case that any prerogatives outside the VASRD were exercised.  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.

RECOMMENDATION:  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 20140514, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

XXXXXXXXXXXXXXXXXXXX
President
Physical Disability Board of Review

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 XXXXXXXXXXXXXXXXXXXX, AR20150014927 (PD201402254)

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:

Encl						     XXXXXXXXXXXXXXXXXXXX
						     Deputy Assistant Secretary of the Army
						          (Review Boards)