RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2015-01691
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20061012

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was a National Guard E5, Combat Engineer, medically separated for “chronic right knee pain,” with a disability rating of 10%.

CI CONTENTION:  The CI makes no contentions.  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 - 20060921	VARD – 20070220	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Right Knee Pain…	5099-5003	10%	Residuals Of Right Knee ACL Reconstruction and Medial Meniscus Repair with Chronic Knee Pain and Mild Degenerative Changes	5260	10%	20061114	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  60%	

ANALYSIS SUMMARY:  

Chronic Right Knee Pain.  According to service treatment records (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI had a history of chronic right knee pain dating to an anterior cruciate ligament (ACL) reconstruction in 1995.  He re-injured the knee during a deployment to Iraq in July 2005, was medically evacuated, and underwent ACL revision surgery that October.  He suffered a meniscal tear from a fall soon after surgery, and underwent an arthroscopic meniscectomy in January 2006 (9 months before separation).  Post-operative STR entries documented improving range of motion (ROM) and minimal or no instability (consistent with that described below in the NARSUM), and the absence of persistent effusion or objective joint impingement.   Magnetic resonance imaging after the final surgery demonstrated surgical changes, but all ligaments and menisci were intact (no effusion reported).  Knee pain persisted and did not respond sufficiently to conservative treatment to permit a return to full duty; orthopedics opined that further surgery was not indicated; and, the CI was referred for MEB.

The 21 August 2006 NARSUM examination, 3 months before separation, documented persistent non-specific pain and the use of a brace (no subjective instability or locking mentioned), and referenced only profile restrictions as functional limitations.  The physical examination recorded tenderness, the absence of effusion, and stability to stress testing in all planes except for mild anterior laxity (Lachman 1A, 5 millimeter translation with firm end point).  Measured ROM was flexion to 135 degrees (normal 140) and extension to 0 degrees (normal 0), specifying painful motion.

A 14 November 2006 VA Compensation and Pension (C&P) examination, 1 month after separation, documented constant pain rated 2-4/10 exacerbated by prolonged sitting, twisting, running, and “occasionally” with walking.  Subjective locking or instability were denied, and the CI was employed full time as a security officer.   The physical examination recorded a normal gait without use of a brace or assistive device, the absence of effusion, stability to stress testing in all planes, and negative signs of impingement (locking).  Measured ROM was flexion to 125 degrees and extension to minus 5 degrees.  The examiner reported pain, fatigue, weakness, lack of endurance, and loss of coordination with repetitions; but, there was no ROM degradation.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the right knee pain condition 10%, coded analogously as 5003 (degenerative arthritis) citing the U.S. Army Physical Disability Agency pain policy.  The VA rated the right knee pain condition 10%, coded 5260 (limitation of flexion) citing the above C&P evidence for pain and other symptoms with repetition.  There was no minimum compensable ROM limitation.  There was no evidence of locking with persistent effusion, fracture with non-union or malunion, or other criterion that would justify a rating higher than 10% under any applicable §4.71a code; and, there were insufficient grounds (and no contention) for separate rating 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 of the right knee condition.  

BOARD FINDINGS:  In the matter of the right knee condition and IAW VASRD §4.71a, the panel unanimously recommends no change in the PEB adjudication.  There are 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 20150629, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

AR20170008715, XXXXXXXXXXXXXXXXXX 

XXXXXXXXXXXXXXXXXX
XXXXXXXXXXXXXXXXXX
XXXXXXXXXXXXXXXXXX

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