RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXXX	CASE:  PD-2014-02935
BRANCH OF SERVICE: Army 	SEPARATION DATE:  20020122

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was a drilling National Guard E-4 (Light Wheel Vehicle Mechanic) medically separated for “chronic left knee pain,” rated at 10%. 

CI CONTENTION:  The CI contends for all of his conditions. 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 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 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 20011126	VA* – (~11 Mos. Post-Separation)	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Left Knee Pain	5259	10%	Residuals, Left Medial Meniscus Tear	5257*	10%*	20021211	
Other MEB/PEB Conditions x 0 (Not In Scope)	Other x 0	
RATING:  10%	RATING:  10%*	
*Derived from VA Rating Decision (VARD) dated 20021220 (most proximate to date of separation [DOS])

ANALYSIS SUMMARY: 

Chronic Left Knee Pain.  In 1999, this CI suffered an injury to his left knee.  Magnetic resonance imaging (MRI) showed a tear in the medial meniscus.  On 27 July 1999, he had arthroscopy with partial debridement of the medial meniscus.  After surgery, he was improved, but he continued to have problems with the left knee.  Due to the chronic, persistent nature of his knee symptoms, an MEB was initiated.  The MEB narrative summary (NARSUM) was dated 2 March 2000.  The CI reported that he was not able to run, or perform his military duties.  On physical examination (PE) the CI’s gait was normal.  PE of the left knee showed minimal pain with internal rotation of the leg, but no joint line tenderness.  He had pain with palpation of the medial femoral condyle.  There was no effusion, and no patellar subluxation.  Tests for ligamentous laxity were negative, and neurovascular exam was normal.  Range-of-motion (ROM) was 0-130 degrees. 

On 6 October 2000, the CI had a second arthroscopic surgery on his left knee, and partial medial meniscectomy was performed.  After surgery, he had knee pain that was worse with sitting activities.  On 4 December 2000, he was seen for follow-up by Orthopedics.  PE of the left knee showed some pain on patellar compression, but no pain with passive flexion.  Muscle strength was normal.  Tests for ligamentous laxity were negative, and ROM was 0-130 degrees. 

The CI was medically separated from service on 22 January 2002.  Eleven months later, in December 2002, he had a VA Compensation and Pension (C&P) exam.  He was working as a bartender and mechanic at that time.  He reported that his left knee continued to give him problems.  He was unable to climb stairs, do gardening, or push a lawnmower due to knee pain. On physical examination (PE) the CI’s posture and gait were normal.  The knees were normal in appearance.  There was no heat, redness, swelling, effusion, drainage, abnormal movement, weakness, or instability.  Left knee ROM was normal, with pain at the end of motion.  Tests for ligamentous laxity were negative.  The CI reported pain during a flare-up, but had no symptoms on the day of that exam.

The goniometric ROM evaluations in evidence which the Board weighed in arriving at its rating recommendation are summarized in the chart below.

Left Knee ROM
(Degrees)	Ortho ~14 mos. Pre-Sep
(20001204)	Ortho ~3 mos. Pre-Sep
(20011025)	VA C&P ~11 Mo. Post-Sep
(20021211)	
Flexion (140 Normal)	130	130	140	
Extension (0 Normal)	0	2	0	

The Board directed attention to its rating recommendation based on the evidence.  The Board determined that the unfitting left knee condition was essentially non-compensable based solely on the VASRD §4.71a diagnostic codes for loss of knee motion (5260 and 5261).  However; IAW VASRD §4.71a, diagnostic code (DC) 5259, a 10% rating is warranted when there is satisfactory evidence of knee symptoms after meniscal surgery.  The CI did have partial removal of his medial meniscus, and post-operatively he had persistent knee symptoms.  There was no path to a higher rating for the left knee since there was insufficient evidence of recurrent subluxation, ligamentous instability, or any other seriously disabling bone or joint abnormality that would justify a higher rating.  After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (resolution of reasonable doubt), the Board found insufficient cause to recommend a change in the PEB adjudication for the chronic left knee pain.  

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 chronic left knee pain, 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 following documentary evidence was considered:
Exhibit A.  DD Form 294, dated 20140610, 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 XXXXXXXXXXXXXXXXXXXX, AR20160005452  (PD201402935)

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