RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXX	CASE:  PD-2015-01107
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20030523

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E3, Armor Crewman, medically separated for “chronic right knee pain,” with a disability rating of 0%.  

CI CONTENTION:  His condition continues to worsen and impact his 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 - 20030403	VARD - 20030425	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Right Knee Pain	5099-5003	0%	Residuals, Status Post ACL Reconstruction; Right Knee	5257	20%	STR	
			Scar, Right Knee	7805	0%		
COMBINED RATING:  0%	COMBINED RATING OF ALL VA CONDITIONS:  20%	

ANALYSIS SUMMARY:  

Right Knee Condition.  According to service treatment records (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s right knee condition after he tripped and fell down a hill while training in April 2002.  A right knee X-ray showed an osteochondroma (benign tumor containing both bone and cartilage) on the posterior lateral femur.  After 2 months of rehabilitation with physical therapy (PT), the CI continued to complain of daily episodes of instability and pain.  A right knee MRI showed a torn anterior cruciate ligament (ACL) and increased signal in the medial meniscus.  On 27 June 2002, the CI underwent endoscopic examination under anesthesia which revealed a complete ACL tear, a parrot beak tear of the medial meniscus posterior horn, and chondromalacia (cartilage softening or degeneration) of the medial femoral condyle and tibial plateau.  The surgeon performed an endoscopic bone-tendon-bone ACL reconstruction and debrided the medial meniscus tear.  Following surgery, further treatment did not result in improvement sufficient to allow unrestricted duty.  The MEB forwarded “recurrent right knee pain and effusion, status post bone-tendon anterior cruciate ligament reconstruction,” for PEB adjudication.  

In the 28 February 2003 NARSUM, 2 months before separation, the CI complained of minimal and occasional right knee pain.  He reported experiencing significant pain and swelling as a result of performing a physical fitness test approximately 1 week before the MEB examination, during which he could not complete the run.  Knee pain prevented him from completing basic training.  The right knee examination revealed a slight effusion (fluid collection) with no edema (excess tissue fluid swelling), erythema (redness), ecchymosis (bruising), or tenderness.  The goniometer measured range of motion (ROM) values were flexion of 130 (140 normal) and extension of 0 degrees (0 normal).  The anterior drawer (assesses ACL), Lachman (assesses ACL), pivot shift (assesses ACL), valgus/varus stress (assesses medial collateral ligament [MCL]/lateral collateral ligament [LCL]), and McMurray (assesses menisci) tests were negative.  Strength, pulses, and deep tendon reflexes (DTRs) were normal.

The Board directed attention to its rating recommendation based on the above evidence.  The PEB assigned a 0% rating under an analogous 5003 code (arthritis, degenerative) citing occasional minimal right knee pain status post ACL reconstruction.  The VA assigned a 20% rating under the 5257 code (knee, other impairment of) based on the service medical records, citing occasional minimal right knee pain status post ACL reconstruction, X-ray findings, no instability by exam, ROM, and rated for moderate impairment.  The VA additionally rated the right knee surgical scar at 0% under code 7805 (scars, other [including linear scars]).  The Board does not recommend disability rating for scars unless their presence imposes a direct functional limitation that renders the CI unfit.  The knee scar did not interfere with wear of military gear and was not painful at the MEB examination.  Any contribution from the scar on ROM limitation was addressed above.  There was insufficient evidence of duty-limiting impairment from the knee scar, thus the Board concluded that the scar condition could not be recommended for additional disability rating.  The ROM values in the proximate exams did not support a minimum rating under the limitation of knee flexion (5260) and extension (5261) codes.  While the CI underwent debridement of a medial meniscus tear, there was no dislocated meniscus (5258) or symptomatic removed meniscus (5259) for consideration under the respective codes.  There was no history of recurrent subluxation or objective evidence of lateral instability to support the minimum slight (10%) rating under 5257 (knee, other impairment of).  Board members agreed that the absence of subluxation or instability excluded the moderate (20%) rating under 5257.  There was no knee ankylosis (5256), tibia and fibula nonunion/malunion (5262), or genu recurvatum (5263) for consideration under the respective codes.  The Board agreed a 10% rating was supported based on VASRD §4.40 (functional loss) or §4.59 (painful motion).  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 right knee condition coded 5003.  

BOARD FINDINGS:  In the matter of the right knee condition, the Board unanimously recommends a disability rating of 10%, coded 5003 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	
Chronic Right Knee Pain	5003	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

AR20170011694, XXXXXXXXXXXXXXXXXXX

XXXXXXXXXXXXXXXXXXX

Dear XXXXXXXXXXXXXXXXXXX:

	The Department of Defense Physical Disability Board of Review (DoD PDBR) reviewed your application and found that your disability rating should be modified but not to the degree that would justify changing your separation for disability with severance pay to a permanent retirement with disability.  I have reviewed the Board’s recommendation and record of proceedings (copy enclosed) and I accept its recommendation.  This will not result in any change to your separation document or the amount of severance pay.  A copy of this decision will be filed with your Physical Evaluation Board records.  I regret that the facts of the case did not provide you with the outcome you may have desired.
  
	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. 

	A copy of this decision has also been provided to the Department of Veterans Affairs.

Sincerely,	
Enclosure