RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXXXX	CASE:  PD-2015-00787
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20070517

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E6, Wheeled Vehicle Mechanic, medically separated for “posttraumatic arthritis right knee following ACL reconstruction,” with a disability rating of 0%.

CI CONTENTION:  His condition continues to worsen and impact daily activities.  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 - 20070420	VARD - 20070918	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Posttraumatic Arthritis Right Knee Following ACL Reconstruction	5010	0%	Post Traumatic Arthritis, Right Knee, S/P Anterior Cruciate Ligament Tear and Reconstruction	5010	0%	STR	
			Residual Scar, S/P Right Knee Surgical Repair	7805	NSC	STR	
COMBINED RATING:  0%	COMBINED RATING OF ALL VA CONDITIONS:  0%	

ANALYSIS SUMMARY:  

Posttraumatic Arthritis Right Knee Following ACL Reconstruction.  According to service treatment records (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s right knee condition began in March 1998 after twisting his knee playing basketball.  Right bone-tendon-bone anterior cruciate ligament (ACL) reconstruction surgery was performed 27 March 1998.  A right knee diagnostic imaging (MRI) study on 5 October 2006 showed an intact ACL graft, postoperative medial meniscus changes, mild medial and lateral compartment osteoarthritis, and a possible lateral meniscus tear.  A 31 October 2006 right knee X-ray showed findings consistent with a prior ACL repair/reconstruction, satisfactory position and alignment of screws (distal femur and proximal tibia), and no significant arthritic features.  The 28 February 2007 medical examination for the MEB (DD Form 2808) physical examination documented a limping gait.  The right knee examination revealed crepitus (grating sensation or sound) and medial and lateral tenderness.  There was no edema (excess tissue fluid swelling), erythema (redness), or effusion (fluid collection).  The range of motion (ROM) was full with pain on flexion and extension.  There was sub-patellar decreased sensation to light touch.  In the 3 April 2007 NARSUM, 6 weeks before separation, the CI complained of chronic, deep, anterior right knee pain.  He denied effusion, instability, locking, or giving way.  Pain was exacerbated by stair climbing and by kneeling.  The CI did not experience significant improvement with activity modification, physical therapy (PT), joint injections, or anti-inflammatory medications.  The examiner referred to the DD Form 2808 for examination details.  The focused right knee examination revealed very minimal quadriceps asymmetry and tenderness along the medial femoral condyle and patella.  There was no joint line tenderness or effusion.  Right knee ROM was flexion of 135 (140 normal) and extension of 0 (0) degrees.  The Lachman test to assesses the ACL was Grade 1+ (< 5mm) / A indicating a firm endpoint.  Other knee tests to include, the pivot shift, posterior drawer, valgus/varus stress, McMurray, and patellar grind, were negative. The examiner recounted the findings of the X-rays and MRI.  The diagnosis listed right knee arthritic changes following ACL reconstruction.  Following surgery further treatment did not result in improvement sufficient to allow unrestricted duty.  The MEB forwarded “right knee arthritic changes following ACL reconstruction,” for PEB adjudication.

The Board directed attention to its rating recommendation based on the above evidence.  The PEB rated the right knee condition 0%, coded 5010 (arthritis, due to trauma, substantiated by X-ray findings, to be rated as arthritis degenerative), citing degenerative changes on both X-ray and MRI.  The VA rated the right knee condition 0%, coded 5010, citing no objective evidence of painful or limited motion.  There was no limitation of flexion or extension that supported a rating under the VASRD diagnostic codes for limitation of motion (5260 or 5261).  The examinations proximate to separation 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) or history of surgery to remove a meniscus (5259) 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).  However, there was evidence of painful motion with functional loss supporting a 10% rating (based on §4.59, §4.40 and §4.45).  After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the Board recommends a disability rating of 10% for the posttraumatic arthritis right knee following ACL reconstruction condition, coded 5010.  

BOARD FINDINGS:  In the matter of the posttraumatic arthritis right knee following ACL reconstruction condition, the Board unanimously recommends a disability rating of 10%, coded 5010 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	
Posttraumatic Arthritis Right Knee Following ACL Reconstruction	5010	10%	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20150603, 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, AR20160018458 (PD201500787)

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