RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXXXX	CASE:  PD-2015-00444
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20030317

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E4, Avenger Crewmember, medically separated for chronic right knee pain, with a disability rating of 0%.

CI CONTENTION:   The CI claimed he was given a higher rating for his conditions by the VA. 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 - 20021203	VARD - 20040124	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Right Knee Pain S/P Right Anterior Cruciate Ligament Rupture And Repair	5099-5003	0%	S/P Right Knee Anterior Cruciate Ligament Repair With Degenerative Joint Disease	5260	10%	STR	
			Laxity, Right Knee	5257	10%	STR	
COMBINED RATING:  0%	COMBINED RATING OF ALL VA CONDITIONS:  20%	

ANALYSIS SUMMARY:  

Chronic Right Knee Pain.  According to service treatment record (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s knee condition began in December 2000 after twisting his right knee while running in physical training.  Radiologic imaging revealed an anterior cruciate ligament (ACL) tear of the right knee.  The Orthopedic provider diagnosed the condition as an ACL rupture and recommended surgical repair.  In August 2001 the CI underwent an ACL repair using harvested hamstring tendons.  Following surgery, further treatment did not result in improvement sufficient to allow unrestricted duty.  The MEB forwarded “right knee pain, chronic status post right ACL repair with residual saphenous nerve parathesia” for PEB adjudication.

A physical therapy (PT) encounter (8 months prior to separation) indicated painful motion of the right knee with flexion of 120 degrees (normal = 140).  At the MEB NARSUM examination on 3 October 2002, 5 months prior to separation, the CI’s chief complaint was “chronic right knee pain”.  His physical examination (PE) revealed a range of motion (ROM) of 115 degrees of flexion (normal = 140) and 0 degrees (normal) of extension.  Global instability tests of the right knee were intact/normal.  “[The CI] does have numbness and {altered sensation} in the saphenous nerve distribution of his right leg”; which corresponds to the inside portion of the lower leg.  There was no VA Compensation and Pension (C&P) examination in evidence (“failed to report”).

The Board directed attention to its rating recommendation based on the above evidence.  The PEB rated the knee condition 0%, analogously coded 5099-5003 (degenerative arthritis), citing the US Army Physical Disability Agency (USAPDA) pain policy.  The VA rated the knee condition 10% coded 5260 (leg, limitation of flexion) and 10% coded 5257 (knee; other impairment), based on the STR citing painful motion, use of crutches, and limited motion.  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 evidence of painful motion with functional loss supporting a 10% rating (based on §4.59, §4.40 and §4.45).  It was further agreed that frequent locking due to dislocated cartilage was not present, and therefore a 20% rating was not justified under the 5258 code.  Board members also considered that given the subjective symptoms of instability in this case, dual coding may be appropriate.  In deliberating an additional rating under the 5257 code, the Board unanimously agreed that the instability tests performed at the NARSUM clearly did not indicate any joint instability.  After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the Board unanimously recommends a separation rating of 10% for the right knee condition coded 5099-5003.  

BOARD FINDINGS:  In the matter of the right 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 the prior medical separation:  

CONDITION	VASRD CODE	PERMANENT RATING	
Chronic Right Knee Pain 	5099-5003	10%	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20150602, 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

SUBJECT:  Department of Defense Physical Disability Board of Review Recommendation for XXXXXXXXXXXXXXXXXXXXX, AR20170000063 (PD201500444)

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