RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2015-00269
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20051014

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E4, Intelligence Analyst, medically separated for “chronic right knee pain…,” with a  disability rating of 10%.

CI CONTENTION:  The CI contended for her right knee, back, and numbness of the legs as well as numerous other 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 on 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 - 20050824	VARD - 20060322	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Right Knee Pain…	5099-5003	10%	Post-Operative Anterior Cruciate Ligament Reconstruction, Right Knee, with Painful and Limited Motion	5260	10%	20051122	
Low Back Pain	Not Unfitting 	Status, Post Trauma, Low Back Pain, with Painful and Limited Motion	5237	10%		
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  20%	

ANALYSIS SUMMARY:  

Right Knee Pain.  According to service treatment records and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI underwent a right anterior cruciate ligament (ACL) reconstruction in September 2001.  The CI did well for approximately 1 year post-surgery but with increased activity she developed persistent right knee pain and effusions.  She underwent a second surgery for removal of hardware in April 2002 and was eventually placed on a permanent profile in March 2003.  Despite treatment, the right knee condition could not be adequately rehabilitated to meet the physical requirements of the CI’s military specialty and she was referred for an MEB.  The MEB forwarded “chronic right knee pain secondary to ACL reconstruction” for PEB adjudication.

At an orthopedic examination on 20 May 2005 (5 months pre-separation), the CI endorsed constant right knee pain as well as swelling and give-way.  Her physical examination (PE) revealed decreased range of motion (ROM) noting knee flexion to 115 degrees (normal 140) and knee extension to -10 degrees (normal 0).  Tenderness was present.  There was no medial or lateral instability present, but a Lachman’s (test for ACL integrity) yielded 5mm of translation with endpoint.  At the 13 July 2005 MEB PE (recorded on DD Forms 2807 and 2808), 3 months prior to separation, the CI reported right knee swelling and pain.   Her PE noted positive ACL laxity.  The MEB NARSUM examination on 25 July 2005 (performed 12 days after the 2807 and 2808 exam forms were completed), noted complaints of continued right knee pain.  Her PE was normal except for a 10-degree deficit in flexion (130 vs. 140) and tenderness about the joint line of the right knee.  A Lachman's test was documented as “stable.”  At the 22 November 2005 VA Compensation and Pension (C&P) evaluation (performed 1 month after separation), the CI reported constant pain in the right knee, rated 4/10 and the knee tended to give way.  The CI could walk for 1 mile or for half an hour.  The right knee had no effect on daily activities and the CI took no pain medication.  The CI used no aids for ambulation.  Her PE revealed no effusion or tenderness.  ROM measurements were recorded as improved from pre-separation testing at 124 degrees flexion and normal extension.  Repetitive motion had no adverse effect to ROM.  All tendon and ligament stability tests were normal.  

The Board directed attention to its rating recommendation based on the above evidence.  The PEB rated the right knee condition at 10%, analogously coded 5099-5003 (degenerative arthritis), citing full ROM without joint instability, “rated for pain, slight, frequent.”  The PEB applied the US Army Physical Disability Agency pain policy in making this determination.  The VA also rated the right knee condition at 10%, coded 5260 (leg, limitation of flexion), based on the C&P examination 1 month after separation, citing objective demonstration of slightly limited and painful motion of the right knee.  There was no degree of motion loss which supported a rating under the diagnostic codes for limitation of flexion or extension (5260, 5261).  However, there was evidence of persistent tenderness with functional loss supporting a 10% rating (based on §4.40 and §4.45) as adjudicated by the PEB.  The Board considered the NARSUM and VA examinations probative as they were most proximate to separation, complete and VASRD compliant. These examinations 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), or history of surgery to remove a meniscus (5259) to support a rating under those 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 was 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 pain condition.  

Contended PEB Condition:  Low Back Pain.  The Board’s main charge is to assess the fairness of the PEB’s determination that the contended condition was not unfitting.  The contended condition was not profiled or implicated in the commander’s statement or judged to fail retention standards.  There was no performance-based evidence from the record that this condition significantly interfered with satisfactory duty performance at or near separation.  After due deliberation, the Board concluded that there was insufficient cause to recommend a change in the PEB’s fitness determination for the contended condition and so no additional disability rating is recommended.

BOARD FINDINGS:  In the matter of the right knee pain condition and IAW VASRD §4.71a, the Board unanimously recommends no change in the PEB adjudication.  In the matter of the contended low back pain condition, the Board unanimously recommends no change from the PEB determination as not unfitting.  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 20150414, 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

22 DEC 2016

SUBJECT:  Department of Defense Physical Disability Board of Review Recommendation for 
XXXXXXXXXXXXXXXXXX, AR20160019322 (PD201500269)

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