RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX		CASE:  PD-2014-03925
BRANCH OF SERVICE:  Army	 SEPARATION DATE:  20011127

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E1, Basic Trainee, medically separated for “chronic pain, left knee, status post debridement of medial meniscus tear,” with a disability rating of 0%.

CI CONTENTION:  The CI requests the Board consider all conditions.  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 based upon a 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 - 20011023	VARD - 20020913	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Pain, Left Knee, Status Post Debridement of Medial Meniscus Tear	5099-5003	0%	Left Knee, Status Post Meniscectomy	5259	10%	STR	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  10%	

ANALYSIS SUMMARY: 

Left Knee Condition.  According to service treatment records (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI sustained a left knee twisting injury on the first day of basic training, approximately 1 year prior to MEB referral.  Left knee magnetic resonance imaging (MRI) on 11 December 2000 showed a medial meniscus (posterior horn) tear, a lateral meniscus (posterior horn) tear, medial collateral ligament strain, bone bruises, chondromalacia patella (patellar cartilage abnormal softening/degeneration), and a joint effusion (fluid collection).  On 25 May 2001, the CI underwent diagnostic left knee arthroscopy and debridement of a medial meniscus bucket-handle tear.  The 18 July 2001 NARSUM by orthopedic surgery, 4 months before separation, recounted the history and interventions.  The CI reported that symptoms were markedly better than preoperatively, but he continued to have medial, greater than lateral, left knee pain.  He could ride a bicycle with mild pain but was unable to run, jump, or hop.  The focused musculoskeletal exam revealed normal lower extremity strength and intact light touch sensation.  The left knee exam revealed well healed arthroscopic portals, 1 cm of quadriceps muscle atrophy, mild medial joint line tenderness, and no effusion.  Left knee active range of motion (ROM) was flexion of 130 (140 normal) and extension of 0 (normal) degrees.  The McMurray (assesses menisci), Lachman (assesses anterior cruciate ligament [ACL]), and valgus/varus stress (assesses medial collateral ligament [MCL]/lateral collateral ligament [LCL]) tests were negative.  The diagnosis listed left medial meniscus tear.  In the 31 August 2001 MEB addendum by orthopedic surgery the CI reported his left knee felt much better than preoperatively.  He complained of slight medial knee pain with prolonged standing and being unable to run.  The physical exam revealed normal lower extremity strength and intact light touch sensation.  The left knee exam revealed well healed arthroscopic portals, mild medial joint line tenderness, and no effusion.  Left knee active range of motion (ROM) was flexion of 135 (140 normal) and extension of 0 (normal) degrees.  The McMurray and Lachman tests were negative.  The diagnosis listed status post debridement of left medial meniscus tear.

The Board directed attention to its rating recommendation based on the above evidence.  The PEB assigned a 0% rating under an analogous 5003 code (arthritis, degenerative) citing chronic left knee pain, status post debridement of medial meniscus tear, and rated as slight/occasional pain IAW USAPDA pain policy.  The VA assigned a 10% rating under the 5259 code (cartilage, semilunar, removal of, symptomatic) based on the Service medical records and noting the CI failed to report for the VA C&P examination.  The VA cited status post arthroscopy and debridement of a medial meniscus bucket-handle tear, mild pain, mild medial joint line tenderness, 1 cm quadriceps atrophy, stable to varus and valgus stress, and negative McMurray and Lachman tests.  The ROM values in the proximate exams did not support a minimum rating under the limitation of knee flexion (5260) and extension (5261) codes.  While the CI underwent debridement of a medial meniscus bucket-handle tear, there was no dislocated meniscus (5258) or symptomatic removed meniscus (5259) for consideration under the respective codes.  There was no knee ankylosis (5256), knee recurrent subluxation/lateral instability (5257), tibia and fibula nonunion/malunion (5262), or genu recurvatum (5263) for consideration under the respective codes.  The Board agreed a 10% rating was supported based on VASRD §4.40 (functional loss) or §4.59 (painful motion).  After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the Board recommends a disability rating of 10% for the left knee condition.  

BOARD FINDINGS:  In the matter of the left knee condition, the Board unanimously recommends a disability rating of 10%, coded 5099-5003 IAW VASRD §4.71a.  There were no other conditions within the Board’s scope of review for consideration.  

The Board recommends that the CI’s prior determination be modified as follows, effective as of the date of his prior medical separation:  

CONDITION	VASRD CODE	RATING	
Chronic Pain, Left Knee, Status Post Debridement of Medial Meniscus Tear	5099-5003	10%	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20140903, with attachments
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

02 DEC 2016

SUBJECT:  Department of Defense Physical Disability Board of Review Recommendation for XXXXXXXXXXXXXXXXXX, AR20160017864 (PD201403925)

1.  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, accept the Board’s recommendation to modify the individual’s disability rating to 10% without re-characterization of the individual’s separation.  This decision is final.  

2.  I direct that all the Department of the Army records of the individual concerned be corrected accordingly no later than 120 days from the date of this memorandum.   

3.  I request that a copy of the corrections and any related correspondence be provided to the individual concerned, counsel (if any), any Members of Congress who have shown interest, and to the Army Review Boards Agency with a copy of this memorandum without enclosures.

 BY ORDER OF THE SECRETARY OF THE ARMY:

CF: 
(  ) DoD PDBR
(  ) DVA