RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2015-00283
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20060530

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E4, Health Care Specialist, medically separated for “hyperextension injury to the left knee” with a disability rating of 10%.

CI CONTENTION:  VA diagnosed PTSD prior to the MEB and it wasn’t considered in the final decision for disability.  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 - 20060227	VARD - 20061116	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Hyperextension Injury to the Left Knee	5099-5003	10%	Status Post Left Knee Meniscus and Ligament Repair	5259	10%	20060503	
Depression	Not Unfitting	Post-Traumatic Stress Disorder with Major Depressive Disorder	9411	50%	20060426	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  60%	

ANALYSIS SUMMARY:

Left Knee.  According to service treatment records (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI underwent left knee surgery in June 2005 for torn ligaments and meniscus.   Following surgery further treatment did not result in improvement sufficient to allow unrestricted duty.  The MEB forwarded painful, unstable left knee for PEB adjudication.  At the time of the orthopedic clinic appointment on 8 August 2005, 6 weeks after surgery and 10 months prior to separation, the CI reported continued hyperextension of his left knee.  On examination there was full range of motion (ROM), normal strength, and a -5 degree of hyperextension.  Tests for instability were negative.  At the MEB NARSUM examination on 27 September 2005, 8 months before separation, the physical examination noted full active ROM and increased laxity in the anterior/posterior Drawer tests.  The knee was stable to Varus and Valgus instability testing and there was no pain with ROM measurements.  

At the 3 May 2006 VA Compensation and Pension (C&P) evaluation, performed a month before separation, the CI reported constant knee pain, giving way, and knee instability.  Physical activity increased the pain but it did not cause incapacitation.  Physical examination showed no signs of edema, effusion, weakness, tenderness, redness, heat, abnormal movement or guarding of movement.  ROM of the left knee was flexion to 130 degrees (140 normal) and normal extension of 0 degrees; with painful motion.  All knee stability tests were within normal limits.

The Board directed attention to its rating recommendation based on the above evidence.  The PEB rated the left knee condition 10%, analogously coded 5099-5003 (degenerative arthritis), citing the US Army Physical Disability Agency pain policy rated as moderate and occasional.  The VA rated the left knee condition 10%, coded 5259 (cartilage, semilunar, removal of, symptomatic), citing reduced flexion due to pain.

The Board agreed there was no limitation of motion to support a rating under the diagnostic codes for limitation of flexion or extension (5260, 5261).  However, there was sufficient evidence of painful motion based on §4.59 to support a 10% rating.  The persistence of pain after meniscal surgery warranted a 10% rating under the 5259 code (cartilage, semilunar, removal of symptomatic) as determined by the VA.  The VA examinations proximate to separation and further away from surgery, 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), 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).

Both painful motion and code 5259 support a 10% rating but only one can be utilized to rate pain IAW with VASRD §4.14 (avoidance of pyramiding); a 10% rating offers no rating benefit to the CI.  There is no grounds for an 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 left knee condition.

Contended PEB Condition: Depression.  The Board’s main charge is to assess the fairness of the PEB’s determination that the contended condition was not unfitting.  The MEB psychiatry consult noted the absence of documentation to indicate a significant decrease in duty performance as a result of any mental illness.  At the time of separation, the CI’s major depressive disorder condition was recorded as “in partial remission”, and the examiner specifically noted in response to an MEB appeal, that the CI did not qualify for a PTSD diagnosis.  The contended condition was not profiled or judged to fail retention standards.  There was no performance-based evidence from the record that the condition significantly interfered with satisfactory duty performance at separation.  After due deliberation, the Board concluded that there was insufficient cause to recommend a change in the PEB fitness determination for the contended condition and so no additional disability rating is recommended.

BOARD FINDINGS:  In the matter of the left knee condition and IAW VASRD §4.71a, the Board recommends no change in the PEB adjudication.  In the matter of the contended depression condition, the Board 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 20150425, w/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 Feb 2017

SUBJECT:  Department of Defense Physical Disability Board of Review Recommendation for 
XXXXXXXXXXXXXXXXXX, AR20160019821 (PD201500283)

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