RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2015-01400
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20050908

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E4, Power Generation Equipment Repair, medically separated for “left knee pain,” with a disability rating of 20%.

CI CONTENTION:  The CI detailed that his right knee has required surgery since his discharge and is not healing correctly and he is having issues with his feet.  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 - 20050518	VARD - 20060223	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Left Knee Pain	5257	20%	S/P Left Knee Anterior Cruciate Ligament Reconstruction	5010-5259	10%	20051221	
COMBINED RATING:  20%	COMBINED RATING OF ALL VA CONDITIONS:  10%	

ANALYSIS SUMMARY:  

Left Knee Pain.  According to service treatment records and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s left knee pain condition began in 2003 following a twisting injury.  The CI subsequently developed mechanical instability with activity.  In February 2004, the CI underwent surgery for anterior cruciate ligament repair.  At the time of the surgery, the CI was found to have a complete tear of his anterior cruciate ligament (ACL) without evidence of injury to the medial and lateral menisci.  Follow up radiographic (X-ray) studies showed the ACL graft intact.  Despite treatment, the left knee condition could not be adequately rehabilitated to meet the physical requirements of the CI’s military specialty and the CI was referred for an MEB.  The MEB forwarded “tricompartmental osteoarthritis posttraumatic of the left knee” for PEB adjudication.  

At the MEB NARSUM examination on 7 February 2005, 7 months prior to separation, the CI reported left knee pain.  Physical examination showed well healed scars that were not tender to palpation (TTP).  There was medial and lateral joint line TTP without effusion.  Left knee range of motion (ROM) showed a normal extension and a flexion of 125 degrees (normal 140).  There was moderate left thigh muscle atrophy and testing for anterior instability showed anterior movement with a firm endpoint (Lachman 2A).  Magnetic resonance imaging (MRI) in 2004 showed hardware fixing the ACL graft, graft intact, and early tricompartmental degenerative changes.  A MEB addendum for ROM measurements reported left knee normal extension and flexion of 95 degrees (normal 140), with painful motion noted.  At the MEB examination (recorded on DD Forms 2807 and 2808) dated March 2005, 6 months prior to separation, physical examination showed moderate effusion with decreased ROM and pain with motion.   

At the 12 December 2005 VA Compensation and Pension (C&P) evaluation, performed 3 months prior to separation, the CI reported the knee had become stiff and painful to bend.  Physical examination showed a limping gait.  He was wearing a left knee brace.  There was effusion and crepitus of the kneecap noted.  Knee ROM measures showed a normal extension and flexion of 125 degrees, with painful motion, with “20 degrees loss of flexion after repetitive use.”  There was no evidence of instability or meniscal pathology.  Left knee X-rays showed post-surgical changes and degenerative joint disease.  

The Board directed attention to its rating recommendation based on the above evidence.  The PEB rated the left knee condition 20%, coded 5257 (knee, other impairment of), citing pain, 2A Lachman’s sign with moderate atrophy of the quadriceps, and reduced ROM.  The VA rated the knee condition 10%, coded 5010-5259 (arthritis), based on the VA C&P examination 3 months after separation, citing symptomatic removal of the semilunar cartilage.  The PEB also rated the knee condition 20% coded 5257 for moderate disability due to recurrent subluxation or lateral instability.  Therefore, the Board reviewed to see if a higher rating was available with any applicable VASRD code.  There was no evidence of severe subluxation or lateral instability to support a 30% rating under the 5257 code (knee, other impairment of).  The MEB examiner determined there was some laxity of the knee with instability testing but with a firm endpoint; the MRI after surgery noted the graft was intact; the VA C&P examination noted no evidence of instability; and, the CI did not report any residual functional instability issues with the knee.  There was no evidence of sufficiently limited ROM for a higher rating based on limitation of motion (5260, 5261).  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).  No additional functional limitation was evidenced by the examinations.  

The Board considered if a dual rating of the knee was warranted for instability and limited motion with imaging evidence of the knee.  However, there was no evidence of instability after surgery that caused any symptoms or significant disability apart from the knee pain.  Therefore, the Board concluded that dual rating of the knee was not indicated in this case.  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 pain condition.  

BOARD FINDINGS:  In the matter of the left knee pain condition and IAW VASRD §4.71a, the Board unanimously recommends no change in the PEB adjudication.  There were no other conditions within the Board’s scope of review for consideration.  The Board, therefore, recommends that there be no re-characterization of the CI’s disability and separation determination.  
The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20150616, w/attachments
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

AR20170006593, 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,					       
						      					
Enclosure