RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2015-00526
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20051007

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E2, Watercraft Operator, medically separated for “chronic right knee,” with a disability rating of 20%.

CI CONTENTION:  The CI requests consideration of all 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 - 20050919	VARD 	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Right Knee Pain (Surgical Residuals)	5257	20%	No VA  Examination in Evidence	
COMBINED RATING:  20%	COMBINED RATING OF ALL VA CONDITIONS:  N/A	

ANALYSIS SUMMARY:  

Chronic Right Knee Pain.  According to service treatment records (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI injured his knee in January 2005.  A meniscal tear was suspected and he underwent arthroscopic surgery the following month (8 months before separation).  A medical meniscal tear was identified and debrided, and an 80% tear of the anterior cruciate ligament (ACL) was identified; but, ACL surgery was deferred because it was not covered by the operative consent.  Other than an orthopedic follow-up entry two weeks after the surgery, there were no outpatient STR entries probative to rating.  The 2-week post-operative note (still non-weight bearing) recorded “medial pain/locking,” “moderate effusion,” and range of motion (ROM) measurements of flexion to 90 degrees (normal 140, minimum compensable 45) and extension 0 degrees (normal).

The NARSUM examination on 4 April 2005 (6 months before separation) documented “intermittent knee instability” without further elaboration of symptoms, and the profile confirmed that a knee brace was indicated “as necessary.”  The NARSUM orthopedist documented consideration of ACL reconstruction surgery; but, given that it was a partial tear “with minimal limitations outside of his MOS duties, the patient elects to continue with non-operative treatment with which I concur.”  The physical examination recorded a non-antalgic gait and normal (5/5) muscle strength.  Specific joint findings were “full active [ROM] ... with no frank evidence of instability ... 1 to 2B Lachman and a 1+ pivot ... no effusion ... no evidence of meniscal pathology at this point.”  The functional limitations documented in the commander’s performance statement were “no running, no jumping, no stretching, and no prolonged standing or sitting.”  As charted above, there was no post-separation VA (or civilian) evidence in this case.  

The Board directed attention to its rating recommendation based on the above evidence.  The PEB’s 20% rating was under code 5257 (knee, other impairment of) that specifies ratings for instability.  Code 5257 provides a 10% rating for “slight” instability, 20% for “moderate,” and 30% for “severe;” members agreed that “severe” was not a reasonable characterization of the instability in evidence.  There was no evidence (frequent effusions, locking, or non-union/malunion) for a rating greater than 10% under any alternative joint code; and, it was noted that code 5259 (cartilage, semilunar, removal of, symptomatic) was applicable to the case and provided for a 10% rating independent of any other criterion.  The Board was compelled in this case to consider the option of separate ratings for instability and ROM limitation (via painful motion, or code 5259 equating to painful motion).  Members agreed, however, that if this approach were taken, the functional evidence for instability, as elaborated in the NARSUM, favored a 10% rating for instability rather than the 20% rating under 5257 conferred by the PEB (logically subsuming painful motion and all disability in the absence of dual ratings).  The functional limitations due to instability (and need for a brace) appeared to be confined to more strenuous activities; and, the CI himself did not find them severe enough to warrant additional surgery.  Having so concluded, members agreed that a recommendation based on separate ratings was not advantageous in this case.  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 of the right knee condition.

BOARD FINDINGS:  In the matter of the right knee 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 20150601, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

SAMR-RB						

MEMORANDUM FOR Commander

22 DEC 2016

SUBJECT:  Department of Defense Physical Disability Board of Review Recommendation for 
XXXXXXXXXXXXXXXXXX, AR20160018743 (PD201500526)

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