RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2014-02366
BRANCH OF SERVICE:  Army	BOARD DATE:  20150526
SEPARATION DATE:  20050625

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E-4 (Armor Crewman) medically separated for chronic pain, right knee status post anterior cruciate ligament (ACL) repair.  The condition could not be adequately rehabilitated to meet the physical requirements of his Military Occupational Specialty or satisfy physical fitness standards.  He was issued a permanent L3 profile and referred for a Medical Evaluation Board (MEB).  “Chronic right knee pain status-post anterior cruciate ligament repair” was forwarded to the Physical Evaluation Board (PEB) IAW AR 40-501.  No other condition was submitted by the MEB.  The Informal PEB adjudicated “chronic pain, right knee status post ACL repair” as unfitting, rated 10%, citing application of the US Army Physical Disability Agency (USAPDA) pain policy.  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 20050427	VA* – Service Treatment Records (STR)	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Pain, Right Knee Status Post ACL Repair	5099-5003	10%	Status Post ACL Repair of Right Knee	5260	10%	STR	
Other x 0 (Not In Scope)	Other x 1 	
RATING:  10%	COMBINED RATING:  30%	
*Derived from VA Rating Decision (VARD) dated 20090629 (most proximate to date of separation [DOS]). **No earlier C&P or VARD, however no change in rating from 2005. 

ANALYSIS SUMMARY:

Chronic Pain, Right Knee Status Post ACL Repair Condition.  The narrative summary notes the CI injured his knee in October 2002 and tore his ACL.  He wore a knee brace and was deployed from January to August 2003 and “served without incident.”  When he returned from deployment, the CI reported left knee instability and pain at an orthopedic examination on 25 September 2003, and the exam noted knee instability and atrophy of his thigh muscles.  The CI underwent surgery to repair the ACL on 2 December 2002.  At orthopedic follow-up visits in March and June 2004, the knee was noted to have “excellent stability,” but the CI continued to report pain and difficulty with bending and squatting.  The orthopedic specialist thought the residual pain was due to development of degenerative arthritis and an MEB was initiated.

At the MEB examination on 16 December 2004, 6 months prior to separation, the CI reported chronic knee pain.  The MEB physical exam noted a slightly antalgic gait with tenderness to palpation of the knee joint lines, a positive patellar grind test, and no swelling or effusion.  There was atrophy of the muscles above and below the right knee, but with normal strength of the right leg compared to the left noted.  Right knee range-of-motion (ROM) was extension-flexion 0 to 100 degrees (normal 140).

The initial VA Compensation and Pension (C&P) examination and the original VARD are not in the available records.  The later VARD on 29 June 2009, cited medical evidence from a VA C&P examination 12 June 2009, but this C&P exam is also not in the record.  The VARD cited exam findings as excerpted below.

Upon examination of your right knee, you had an antalgic gait, and there was no ankyloses, abnormal weight bearing, loss of bone, or inflammatory arthritis.  You had right knee crepitation, weakness, click/snaps and grinding, no instability or patellar/meniscus abnormality.  You had 0 to 110 degrees of motion with pain and there were no additional limitations after repetition.  X-rays showed status postoperative cruciate ligament repair.

The Board directed attention to its rating recommendation based on the above evidence.  The PEB rated the knee condition 10%, coded 5099-5003 (analogous to degenerative arthritis) and cited the USAPDA pain policy.  The original VARD is not in the records as noted above.  However, the later VARD on 29 June 2009 indicated that a 10% rating for the knee, coded 5260, was being continued with an effective date of 26 June 2005, the day after military separation.  The evidence noted in the 2009 VARD is too remote from separation to have significant probative value for the Board’s rating recommendation, however, it is included in this case because it provides indirect evidence of the condition of the knee at separation.  The Board agreed that the evidence in record supports a 10% rating of the knee coded either as 5003 for degenerative arthritis of one joint with evidence of limited motion or coded as 5260 for painful motion IAW VASRD §4.59 (painful motion).  The Board reviewed the evidence to see if a higher evaluation was achieved with any applicable code.  However, there was no evidence to support a higher rating based on ROM alone (5260, flexion) or (5261, extension); meniscal injury with locking and frequent effusions (5259, symptomatic semilunar cartilage); ankyloses (5256); or, femur, tibia or fibula impairment (5255, 5262).  The Board also considered if there was evidence for higher or additional rating of the knee based on instability (5257, other knee impairment), but evidence in the STR documented the knee was stable after surgery, as did the medical evidence cited by the remote VARD, and therefore rating for instability could not be recommended.  The Board thus determined that the evidence supports a 10% rating and no higher.  The Board also noted that the PEB’s reliance on the USAPDA pain policy was not detrimental to arriving at the highest rating and, in this case, rating according to VASRD 5003 criteria also results in a 10% rating for the knee condition; therefore, no change to the PEB’s coding choice is recommended.  After due deliberation, and in consideration of the preponderance of the evidence, the Board concluded that there was insufficient cause to recommend a change in the PEB adjudication for the 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.  As discussed above, PEB reliance on the USAPDA pain policy for rating the knee condition was operant in this case and the condition was adjudicated independently of that policy by this Board.  In the matter of the right 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 20140520, 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, AR20160000288 (PD201402366)

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