RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2015-00121
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20050325

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an Army National Guard E4, General Construction Equipment Operator, medically separated for “left knee pain,” with a disability rating of 0%.

CI CONTENTION:  The CI makes no specific contention.  The 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 - 20050210	VARD - 20041005	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Left Knee Pain	5257	0%	Residuals, Left Knee ACL Tear S/P Reconstruction Surgery	5259	10%	20040909	
COMBINED RATING:  0%	COMBINED RATING OF ALL VA CONDITIONS:  10%	

ANALYSIS SUMMARY:  

Left Knee Pain.  According to service treatment records and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI injured his knee in June 2000 after jumping down from a truck and subsequently underwent a left knee anterior cruciate ligament (ACL) hamstring reconstruction surgery in October 2000.  Following a re-injury to the left knee in July 2003, a second ACL reconstruction surgery with a tibialis allograft was performed in October 2003.  In August 2004 the CI had continued pain, underwent arthroscopy, and was diagnosed with grade III chondromalacia of the medial and lateral femoral condyles as well as the patellofemoral joint.  He then underwent resection of the frayed cartilage in the patellofemoral joint and removal of a cyclops lesion (localized arthrofibrosis status post ACL reconstruction) just anterior to the intact ACL.  
Following surgery, further treatment did not result in improvement sufficient to allow unrestricted duty.  The MEB forwarded “left knee pain status post two [ACL] reconstructions” for PEB adjudication.  At the 9 September 2004 VA Compensation and Pension (C&P) evaluation, performed 7 months before separation, the CI reported that after 3 weeks since surgery, he felt intermittent looseness, pain and swelling, but no instability.  Examination showed flexion limited to 90 degrees (normal 140) without pain, some swelling and no instability.  

The MEB NARSUM, dated 15 October 2004, noted the CI continued to experience pain following surgeries.  Upon examination, the knee showed full extension and flexion of 130 degrees and full extension (0 degrees) with pain at extreme ranges of motion.  The CI experienced pain when tightening the quadriceps and had a positive patellar grind test.  Motor and sensory components were normal.  The CI had a 1+ Lachman’s test (ACL instability), but had a positive endpoint.  During the MEB examination (recorded on DD Forms 2807-1 and 2808) dated 18 October 2004, 5 months prior to separation, the examiner noted decreased left knee ROM with weakness and quadriceps atrophy. 

At the time of the physical therapy clinic ROM appointment on 9 November 2004, the CI had flexion of 121 degrees and normal extension.  At the 31 March 2005 orthopedic examination, the CI reported a constant dull ache with crepitus (grinding).  On examination, the ROM flexion was 130 degrees with full extension, mild swelling with tenderness, and no instability.  At a follow-up orthopedic clinic appointment on 30 June 2005, the CI reported continued significant knee pain without instability.  The examiner noted flexion of 130 degrees and normal extension without instability.  An MRI in July 2005 demonstrated an intact reconstructed ligament with minimal anterior subluxation of the tibia with respect to the femur.  Degenerative joint disease was at the knee with scarring at the infrapatellar fat pad.  The menisci and collateral ligament were normal in appearance.  

The Board directed attention to its rating recommendation based on the above evidence.  The PEB rated the left knee condition 0%, coded 5257 (knee, other impairment of: recurrent subluxation or lateral instability).  The VA rated the left knee condition 10%, coded 5259 (cartilage, semilunar, removal of, symptomatic), citing limited motion with pain due to residuals of a healed injury.  There was no limitation of flexion or extension that supported a rating under the VASRD diagnostic codes for limitation of motion (5260 or 5261).  The examinations proximate to separation did not demonstrate the presence of ligamentous instability or laxity (5257), and there was no history of dislocated meniscus or loose body causing frequent locking with recurrent effusions (5258).  However, there was a history of surgery to remove frayed cartilage of a meniscus (5259) to support a rating of 10% under that code.  However, there was no route to a higher rating.  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 pain condition, coded 5259.

BOARD FINDINGS:  In the matter of the left knee pain condition, the Board unanimously recommends a disability rating of 10%, coded 5259 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 the prior medical separation:  

CONDITION	VASRD CODE	PERMANENT RATING	
Left Knee Pain	5259	10%	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20150125, 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

21 DEC 2016

SUBJECT:  Department of Defense Physical Disability Board of Review Recommendation for 
XXXXXXXXXXXXXXXXXX, AR20160018478  (PD201500121)

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