RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2015-00339
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20061214

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E3, Military Police, medically separated for “chronic right knee pain,” with a disability rating of 10%.  

CI CONTENTION: The CI discusses employment limitations due to the unfitting condition for which he was separated.  His 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 - 20060905	VARD – No Claim Filed	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Right Knee Pain	5099-5003	10%	No VA Entry	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  No Rating	

ANALYSIS SUMMARY:  

Right Knee Pain.  According to the service treatment record and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s right knee condition began pre-enlistment (November 2000) after sustaining a football injury and undergoing anterior cruciate ligament (ACL) reconstruction surgery.  He reinjured the right knee and had another ACL surgery in April 2002 (also pre-enlistment).  The CI did well until November 2005, at which time he noticed a mild pop and giving way while running.  In February 2006, the CI underwent diagnostic arthroscopy with debridement and removal of hardware associated with his ACL reconstructions.  Following surgery, further treatment did not result in improvement sufficient to allow unrestricted duty. The MEB forwarded “chronic right knee pain after ACL reconstruction” for PEB adjudication.  

At the primary care visit on 09 November 2005, 3 months prior to the CI’s most recent surgery and 13 months prior to separation, physical examination (PE) showed tenderness at the medial tibial plateau.  There was no crepitus or deformity in the right knee.  He had full active range of motion (ROM) and no instability.  The examiner noted an antalgic gait under observation, but recorded the gait as normal when the CI thought he was unobserved.  

At the May 2006 MEB examination (recorded on DD Forms 2807 and 2808), 4 months status post (s/p) surgery and 7 months before separation, the CI reported right knee pain, exacerbated by bending and straightening the knee.  Swelling occurred after prolonged standing.  The CI said the right knee locked and gave way causing severe pain.  The PE showed tenderness to palpation under the knee cap, and limited painful ROM with decreased flexion and extension.  There was right quadriceps muscle atrophy (compared with left), and slight right lower extremity weakness (below knee), with motor strength 4/5.  The CI was unable to perform a heel or toe walk, and limping was noted.  

During the MEB NARSUM examination on 10 August 2006, 4 months prior to separation, the CI reported intolerance to long-term standing, sitting or walking.  PE showed tenderness to palpation over the patellar tendon.  There was no effusion or erythema.  ROM testing showed 125 degrees of flexion (normal 140) and 0 degrees of extension (normal).  All tests for ligamentous instability were negative with the exception of the Lachman (for ACL integrity), which showed 2 mm of anterior translation with a firm end point (graded as 1-A Lachman).  

The Board directed attention to its rating recommendation based on the evidence above.  The Army PEB rated the right knee condition 10%, coded 5099-5003 (analogous to degenerative arthritis), citing no instability.  The PEB used the US Army Physical Disability Agency pain policy, describing the CI’s pain as “slight/constant.”  

There was no limitation of motion which supported a rating under the diagnostic codes for limitation of flexion or extension (5260, 5261). However, there was sufficient evidence of painful motion with functional loss supporting a 10% rating (based on §4.10, §4.40, §4.45, and §4.59) as adjudicated by the PEB.  The examinations proximate to separation did not demonstrate the presence of ligamentous instability or laxity.  The knee was stable.  Even with a “Lachman 1-A” noted at the August 2006 NARSUM exam, there was not sufficient evidence of joint instability or ligamentous laxity to justify a separate disability rating.  There was no history of dislocated meniscus or loose body causing frequent locking with recurrent effusions, to support a rating under VASRD code 5258.  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 found insufficient cause to recommend a change in the PEB adjudication for the chronic right knee pain condition.  

BOARD FINDINGS:  In the matter of the chronic right knee pain condition 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 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 20150530, 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

20 DEC 2016

SUBJECT:  Department of Defense Physical Disability Board of Review Recommendation for 
XXXXXXXXXXXXXXXXXX, AR20160018683 (PD201500339)

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