RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2015-00954
BRANCH OF SERVICE:  Army	SEPARATION DATE:  20080627

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E6, Petroleum Supply Specialist, medically separated for “osteoarthritis left knee after an ACL reconstruction…and medial meniscus repair… ” with a disability rating of 10%.

CI CONTENTION:  Used evidence supports a higher rating for the left knee condition.  The complete submission is at Exhibit A.

SCOPE OF REVIEW:  The panel’s scope of review is defined in DoDI 6040.44.  It is limited to review of disability ratings assigned 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 or non-compensable.  Any conditions outside the panel’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 panel’s authority is limited to assessing the fairness and accuracy of PEB rating determinations and recommending corrections, where appropriate.  The panel’s assessment of the PEB rating determination 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(s) at the time of separation.  The panel 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 panel 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 - 20080327	VARD - 20080811	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Osteoarthritis Left Knee…	5003	10%	Residuals Left Knee ACL&  Meniscus Tears	5010-5260	10%	20080404	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  10%	

ANALYSIS SUMMARY:

Left Knee.  According to service treatment records and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI left knee condition began in August 2002 after a twisting injury.  He underwent left knee anterior cruciate ligament surgery in 2002 and medial meniscus repair, chondroplasty, and partial debridement of the posterior collateral ligament (PCL) surgery in March 2007.

At the 7 January 2008 orthopedic clinic visit, 6 months before separation, the CI reported increased left medial knee pain/grinding without episodes of locking, effusions or give way.  Physical examination showed a normal gait with left knee medial joint line tenderness.  The range of motion (ROM) was flexion to 130 degrees (normal 140) and extension to 0 degrees (normal 0).  Painful motion and repetition were not addressed.  At the 28 February 2008 MEB NARSUM examination, 4 months before separation, the CI reported increased left knee medial pain with grinding but no locking, effusion or give way; exacerbated by running or jumping.  Physical examination noted a normal gait and well-healed incisions with medial joint line tenderness.  A McMurray test (for meniscal signs) and effusion were negative.  The active-goniometric ROM was flexion to 130 degrees and extension 0 degrees.  Painful motion and repetition were not addressed.

At the 4 April 2008 Compensation and Pension (C&P) evaluation, performed 3 months before separation, the CI reported persistent pain with ROM crepitus, and aching and stiffness with cold or damp weather; wore a brace intermittently.  Physical examination showed a well-healed scar.  Lachman test (for ACL laxity) and McMurray testing were negative.  The ROM was flexion to 130 degrees and extension 0 degrees; painful motion was addressed.  No additional limitations noted with three repetitions of ·movement for pain, fatigue, incoordination, weakness or lack of endurance.

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the left knee condition 10%, coded 5003 (degenerative arthritis), citing pain limited motion.  The VA also rated the left knee condition 10%, analogously coded 5010-5260 (arthritis due to trauma-leg limitation of flexion) based on the C&P 3 months before separation, citing painful or 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 prior meniscal surgery and functional loss supporting a 10% rating (based on §4.59, §4.40 and §4.45) as adjudicated by the PEB.  The analogous 5259 code (cartilage, semilunar, removal of, symptomatic) was applicable as an alternative coding in this case, but the maximum 10% rating under that code provided no rating benefit to the CI, and includes painful motion.  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) 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).  There was 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 panel 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 left knee condition and IAW VASRD §4.71a, the panel unanimously recommends no change in the PEB adjudication.  There were no other conditions within the panel’s scope of review for consideration.  The panel, therefore, recommends that there be no modification or re-characterization of the CI’s disability and separation determination.

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20150518, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

AR20170008420, XXXXXXXXXXXXXXXXXX

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Dear XXXXXXXXXXXXXXXXXX:

	The Department of Defense Physical Disability Board of Review (DoD PDBR) reviewed your application and found your separation disability rating and your separation from the Army for disability with severance pay to be accurate.  I have reviewed the Board’s recommendation and record of proceedings (copy enclosed), and I accept its recommendation.  I regret to inform you that your application to the DoD PDBR is denied.  

	This decision is final.  Recourse within the Department of Defense or the Department of the Army is exhausted; however, you have the option to seek relief by filing suit in a court of appropriate jurisdiction.

Sincerely,