RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXX	CASE:  PD-2015-01111
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20030124

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty, E2, Trainee, medically separated for “right knee pain,” with a disability rating of 0%.

CI CONTENTION:  His condition continues to worsen and negatively 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 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 – 20021223	VARD - 20030510	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Right Knee Pain, Status Post ACL Reconstruction and Subtotal Medial Meniscectomy	5099-5003	0%	S/P ACL Reconstruction and Subtotal Medical Meniscectomy	5257	30%	20030501	
COMBINED RATING:  0%	COMBINED RATING OF ALL VA CONDITIONS:  30%	

ANALYSIS SUMMARY:  

Right Knee.  According to service treatment records (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s right knee condition began in September 2001 after falling, prior to entering military service.  He reinjured his right knee in May 2002 during basic training while jumping over a duffle bag.  A 30 May 2002 right knee X-ray was normal and showed no evidence of fracture, dislocations, or any other bony abnormality.  A right knee diagnostic imaging (MRI) study showed medial meniscus tears, an anterior cruciate ligament (ACL) tear, and possible lateral collateral ligament (LCL) tear.  On 24 July 2002, the CI underwent right bone-tendon-bone ACL reconstruction.  The 14 August 2002 right knee range of motion (ROM) measured by physical therapy (PT) was flexion of 125 (140 normal) and extension of 0 (0 normal) degrees.  The 19 November 2002 NARSUM, 2 months before separation, documented “This is a 22-year old active duty basic trainee who injured his right knee while jumping over a duffel bag in the barracks in May 02.  Subsequent examination demonstrated a torn ACL to his right knee.  He underwent rehabilitation and bone-tendon-bone ACL reconstruction on 24 JUL 02.  Since that time, he has been in physical therapy.”  The right knee examination revealed a well-healed scar with no joint line tenderness or effusion (fluid collection).  Right knee ROM was flexion of 135 (140) and extension of 0 (0) degrees.  The valgus/varus stress (assesses medial collateral ligament [MCL]/lateral collateral ligament [LCL]) test showed no instability and the Lachman (assesses ACL) test was 1-A (Grade 1: < 5mm translation-A = firm endpoint).  The diagnosis listed right knee pain status post ACL reconstruction and subtotal medial meniscectomy.  An 11 February 2003 right knee X-ray showed postsurgical changes with normal bony anatomy, normal meniscal spaces, and no evidence of dislocation or other significant abnormality.  

The 1 May 2003 Compensation and Pension (C&P) examination, 3 months after separation, recounted the history and interventions.  The CI complained of daily, aching right knee pain.  Pain was exacerbated by knee bending, weight bearing, ladders, running, or inadvertently twisting the knee and was not relieved by a soft brace.  The examiner recorded “he feels like it is going to buckle, but it shifts briefly medial to lateral.  The veteran feels a ‘dislocation’ in the knee at least once or twice a week.”  The CI reported painful motion but denied additional limitation on repetitive use or flare-ups.  The physical examination documented a careful antalgic gait without limp.  The right knee examination revealed a well-healed asymptomatic scar, slight subpatellar crepitation (grating sensation or sound), minimal puffiness, and no quadriceps atrophy.  There was tenderness on deep palpation over the medial plica (synovial membrane fold) area and minimal discomfort on pressing the patella.  Right knee ROM was flexion of 130 (140) and extension of 0 (0) degrees.  Medial to lateral (varus stress/MCL) instability was 2+ (6-10 mm translation), otherwise knee instability was 1+ (< 5 mm translation).  The diagnosis listed residual pain and instability status post ACL injury and reconstruction and partial medial meniscectomy.  A 9 June 2003 right knee MRI showed postsurgical changes, intact ACL graft, PCL, MCL, LCL, and menisci, no effusion, and early/mild medial compartment degenerative changes.  

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 minimal and intermittent right knee pain, status post ACL reconstruction and subtotal medial meniscectomy.  The VA, 3 days after separation, assigned a 10% rating under an analogous 5257 code (knee, other impairment of) based on the STR, citing minimal and intermittent right knee pain, status post ACL reconstruction and subtotal medial meniscectomy, ROM, and no joint line tenderness, effusion, or varus/valgus instability.  The VA, 4 months after separation, assigned a 30% rating under the 5257 code (knee, other impairment of).  The ROM values in the proximate examinations did not support a minimum rating under the limitation of knee flexion (5260) and extension (5261) codes.  While the CI underwent a subtotal medial meniscectomy, there was no dislocated meniscus (5258) or symptomatic removed meniscus (5259) for consideration under the respective codes.  There was no knee ankylosis (5256), tibia and fibula nonunion/malunion (5262), or genu recurvatum (5263) for consideration under the respective codes.  Board members agreed that the instability more closely approximated the slight (10%) than the moderate (20%) rating under 5257 (knee, other impairment of).  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 5257.  

BOARD FINDINGS:  In the matter of the right knee pain condition, the Board unanimously recommends a disability rating of 10%, coded 5257 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	
Right Knee Pain	5257	10%	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20150609, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

AR20170011695, 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