RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2015-00836
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20031226

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E4, Network Systems Operator, medically separated for “chronic left knee pain” and “chronic right knee pain secondary to meniscus injury,” rated 10% and 10%, respectively, with a combined disability rating of 20%.  

CI CONTENTION:  “Review 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 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 - 20031028	VARD - 20050523	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Left Knee Pain	5257	10%	Mild Left Knee Instability	5257	10%	20050331	
			Left Knee Mild Osteoarthritis…	5010-5260	10%		
Chronic Right Knee Pain	5257	10%	Mild Right Knee Instability…	5257	20%		
COMBINED RATING:  20%	COMBINED RATING OF ALL VA CONDITIONS:  40%	

ANALYSIS SUMMARY:  

Left Knee Pain.  According to service treatment records (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s left knee condition began in October 2000 without specific injury or trauma.  Radiographic studies showed degenerative joint disease and hardware present in the left knee.  Surgical procedures were performed April 2001, February 2003 and June 2003.  Following surgery further treatment did not result in improvement sufficient to allow unrestricted duty. The MEB forwarded “chronic knee pain, s/p ACL reconstruction” for PEB adjudication.  

The MEB NARSUM examination on 2 October 2003, 2 months prior to separation, noted complaints of left knee pain and physical therapy 3-5 times weekly.  The physical examination showed a full range of motion (ROM), no tenderness, normal gait, normal Lachman’s (test of anterior cruciate ligament (ACL) integrity) and a negative McMurray’s (test for knee cartilage damage) and negative Varus and Valgus tests (no instability.)  He continued with physical therapy for both knees 3-5 times per week and had been having this for the past 10-12 months.  He could walk, bicycle, do push-ups and sit-ups but could not run or ruck march or walk on uneven terrain.  

The STR, dated 15 December 2003, noted worsening chronic knee pain for which the CI was taking non-steroidal pain medication without relief.  Narcotic pain medication was ordered.  At the 31 March 2005 VA Compensation and Pension (C&P) evaluation, performed 15 months after separation, the CI reported pain in left knee with instability and no reported incapacitating episodes.  The physical exam showed multiple scars from previous surgeries and painful flexion in the left knee joint to include some instability.  The examiner opined that the CI had full flexion and extension with a mild gait due to pain.  Repetitive motion produced increased pain, fatigability and a decrease in ROM with at least 5 degrees.  MRI of the left knee showed a tear of the anterior cruciate ligament and suggesting a bucket-handle tear of the medial meniscus.

The Board directed attention to its rating recommendation based on the above evidence.  The PEB rated the left knee pain 10%, coded 5257 (knee, other impairment of), citing full ROM and chronic pain with ambulation.  The VA rated the left knee pain 10% coded 5257 (knee, other impairment of), based on the VA C&P examination 15 months after separation, citing mild instability and 10% analogously coded 5010-5260 (leg, limitation of flexion), citing mild instability and mild osteoarthritis and anterior cruciate ligament (ACL) tear.  

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) as adjudicated by the PEB.  The Board noted the CI had 3 ACL surgeries, suggesting vulnerability to re-injury.  He had undergone PT 3-5 times per week for the past 10-12 months, suggesting moderate rather than slight disability, according to the 5257 disability.  In addition the PEB acknowledged the presence of slight instability, supporting a moderate level of disability.  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 left knee condition.  

Right Knee Pain.  According to service treatment records (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s right knee condition began in October 2000 without any specific injury or trauma.  There was no surgical indication recommended.  The MEB forwarded “chronic knee pain” for PEB adjudication.  An orthopedic examination on 12 June 2003, 6 months, after separation, the CI stated that he had blown his right knee and noted a previous ACL injury.  The physical examination showed a +2 Lachman’s and a +2 Drawer each supporting instability.  

The MEB NARSUM examination on 2 October 2003, 2 months prior to separation, noted complaints of pain and tenderness.  The physical examination showed full range of motion (ROM).  There was medial joint line tenderness with likely inflammation of part of the knee (plica.) there was a positive valgus test (test of medial joint laxity.)  The examiner further noted that the CI’s right knee was unstable and recommended surgical correction for meniscal damage and anterior cruciate ligament (ACL) reconstruction.  He continued with physical therapy for the knee 3-5 times per week and had been having this for the past 10-12 months.  He could bicycle, walk and do push-ups, sit-ups and weight training but no running or ruck marching.  At the 31 March 2005 VA Compensation and Pension (C&P) evaluation, performed 15 months after separation, the CI reported pain in the right knee.  The physical examination showed mild pain during flexion, mild instability from the ACL and full flexion and extension of the right knee joint.  MRI showed anterior tear of the ACL with another tear of the posterior horn of the medical meniscus.

The Board directed attention to its rating recommendation based on the above evidence.  The PEB rated the right knee condition 10%, coded 5257 (knee, other impairment of), citing instability and pain.  The VA rated the right knee condition 20% coded 5257 (knee, other impairment of), based on the VA C&P examination 15 months after separation, citing instability and a tear of the ACL.  

The MEB NARSUM, 2 months prior to separation, noted instability in the right knee.  An orthopedic examination on 12 June 2003, 6 months, after separation, the CI stated that he had blown his right knee and noted a previous ACL injury.  The physical examination showed a +2 Lachman’s and a +2 Drawer each supporting a test for instability.  At the 31 March 2005 VA Compensation and Pension (C&P) evaluation, performed 15 months after separation, the physical exam showed mild pain during flexion, mild instability from the ACL and full flexion and extension of the right knee joint.  He could bicycle, walk and do push-ups, sit-ups and weight training but no running or ruck marching.  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 left 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.  In the matter of the left knee 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 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 
XXXXXXXXXXXXXXXXXX, AR20170000800 (PD201500836)

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