RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXXXX	CASE:  PD-2015-00644
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20060414

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E5, Financial Management Technician, medically separated for “chronic left knee pain…,” with a disability rating of 10%.

CI CONTENTION:  The CI requested a review 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 - 20060202	VARD - 20000406	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Left Knee Pain…	5003	10%	Fracture of the Left Tibial Plateau	5260	10%	20000211	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  20%	

ANALYSIS SUMMARY:  

Chronic Left Knee Pain.  According to service treatment records and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s left knee condition began in March 1999 after falling down stairs.  She sustained a left tibial plateau fracture and tore the anterior cruciate ligament (ACL).  She was casted for the fracture, but deferred knee surgery for ACL repair at the time.  She reinjured her left knee again in November 2002 during unspecified activity.  Diagnostic imaging studies on 14 May 2003 showed a complete tear of the ACL.  There was a medial meniscus tear (MMT) and an osteochondral defect of the medial femoral condyle.  Left knee arthroscopy with ACL reconstruction and debridement of the MMT was performed 28 October 2003.  Following surgery further treatment did not result in improvement sufficient to allow unrestricted duty.  The MEB forwarded “left knee pain, status post anterior cruciate ligament reconstruction,” for PEB adjudication.  

During the MEB NARSUM examination dated 6 January 2006, 3 months prior to separation, the CI reported left knee pain, mostly on the anterior aspect of the knee, described as slight and occurring occasionally.  The pain prevented her from running.  Physical examination showed joint line tenderness and guarding with instability testing (pivot shift), but there was no instability noted and no effusion.  On examination the left knee range of motion (ROM) following repetitive movement was flexion 110 degrees (normal 140) and extension 0 degrees (normal 0).
    
At the 14 February 2006 VA Compensation and Pension (C&P) evaluation, performed 2 months before separation, the CI reported intermittent left knee pain rated at 9/10 scale during flare-ups as well as stiffness, weakness, giving way, fatigability, lack of endurance, lock-up, and swelling.  The pain was aggravated by physical training, marching, prolonged weight-bearing and everyday activities.  The pain was relieved by rest and a joint supplement (glucosamine).  She was able to perform normal daily activities, but had to roll to push up to get from a lower level and was slowed down when walking for prolonged periods or during recreational activity.  Physical examination showed normal gait.  Patellofemoral crepitus was noted and she had left tibial tenderness to palpation.  Examination tests for ligamentous instability and meniscus pathology were negative.  On examination the left knee ROM following repetitive movement was flexion 90 degrees and extension 0 degrees with painful motion.  

The Board directed attention to its rating recommendation based on the above evidence.  The PEB rated the left knee condition 10%, coded 5003 (arthritis, degenerative), citing a major joint with radiographic evidence of degenerative joint disease and slight loss of motion.  The VA rated the left knee condition 10%, coded 5260 (leg, limitation of flexion of), citing painful limitation of motion.  A 10% rating for the left knee was supported under multiple codes.  There was radiographic evidence of arthritis with limited motion for a 10% under 5003 as adjudicated by the PEB or for painful motion with functional loss (based on §4.59, §4.40 and §4.45) under 5260 or for pain following meniscal surgery under 5259 (cartilage, semilunar, removal of, symptomatic).  There was no limitation of motion which supported a higher rating under the diagnostic codes for limitation of flexion or extension (5260, 5261).  The examinations after the 2003 ACL repair 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 non-union, or malunion of the tibial fracture or of the femur to support higher rating under the respective codes for knee impairment related to long bone conditions (5255, 5262).  No additional functional limitation was evidenced by the examinations.  There is 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 chronic left knee pain condition. 

BOARD FINDINGS:  In the matter of the chronic left knee pain condition and IAW VASRD §4.71a, the Board unanimously or majority 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 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, AR20170000439 (PD201500644)

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