RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2014-02607
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20081022

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty, E5, Heavy Construction Equipment Operator, medically separated for “right anterior knee pain,” with a disability rating of 10%.  

CI CONTENTION:  The CI contends for PTSD which was not identified by either the MEB or PEB. The applicant’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 - 20080718	VARD - 20090204	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Right Anterior Knee Pain Due to Laceration	5099-5003	10%	Right Knee Tendonitis	5260	10%	20080730	
			Residuals Right Thigh Laceration Scar	7801	10%	20080730	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  30%	

ANALYSIS SUMMARY:  

Right Knee Pain.  According to service treatment records and Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI incurred a deep laceration to the right thigh from a circular saw while deployed to Afghanistan in February 2007.  The healing course was complicated and the wound finally closed after about 2.5 months.    Radiographic studies showed a normal right knee, and Magnetic Resonance Imaging was within normal limits.  An Orthopedics evaluation indicated he was not a surgical candidate.  Despite treatment, the CI’s knee pain could not be adequately rehabilitated to meet the physical requirements of the CI’s military specialty and was referred for a MEB.  At an Orthopedic clinic appointment in August 2007, the CI complained of pain in his right knee with running and weight bearing activities, and any lateral motion on his knee made it feel like it would give way.  On examination, there was a limping gait, mild tenderness over the medial joint line, and a positive McMurray's (indicating possible meniscus pathology).  Tests for ligamentous instability were negative. There was full active range of motion.  At the MEB NARSUM dated 31 January 2008 (9 months before separation), the CI reported knee pain with activities of daily living.  He was unable to run and denied any locking or giving way.  On examination of the knee, there was no tenderness, swelling, effusion, or ligamentous instability.  The range of motion was mildly limited in flexion, at 130 degrees (normal 140).   

At the VA Compensation and Pension (C&P) examination on 30 July 2008, performed 3 months before separation, the examiner noted some crepitus, but no tenderness, ligamentous instability, or signs of meniscus (semi-lunar cartilage) pathology.  The ROM was mildly limited in flexion at 130 degrees (normal 140); with objective evidence of pain and no additional limitations after three repetitions.   

The Board directed attention to its rating recommendation based on the above evidence.  The PEB rated the right knee condition 10%, coded 5003 (analogous to arthritis), and citing painful motion.  The VA also rated the right knee condition 10%, coded 5260 (limitation of flexion) citing limited leg flexion based on the pre-separation C&P examination.  There was no limitation of motion which attained a minimum 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 examinations proximate to separation did not demonstrate the presence of ligamentous instability or laxity (5257), frequent locking with effusions or any indication of dislocated meniscus or loose body (5258), or history of surgery to remove a meniscus (5259) 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).  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, 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:  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.  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 20140523, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

AR20160007632, XXXXXXXXXXXXXXXXXX

XXXXXXXXXXXXXXXXXX

Dear XXXXXXXXXXXXXXXXXX:

	The Department of Defense Physical Disability Board of Review (DoD PDBR) reviewed your application and found your separation disability rating and your separation from the Army for disability with severance pay to be accurate.  I have reviewed the Board’s recommendation and record of proceedings (copy enclosed), and I accept its recommendation.  I regret to inform you that your application to the DoD PDBR is denied.  

	This decision is final.  Recourse within the Department of Defense or the Department of the Army is exhausted; however, you have the option to seek relief by filing suit in a court of appropriate jurisdiction.

Sincerely,					      
						      					
Enclosure