RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2015-01700
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20041202

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E4, Infantryman, medically separated for “right knee pain,” with a disability rating of 10%.

CI CONTENTION:  The CI requests the Board consider all conditions.  His 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 - 20041015	No VA Claim	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Right Knee Pain	5099-5003	10%	NA	
			
Chronic Left Knee Pain	Not Unfitting					
Chronic Lower Back Pain	Not Unfitting					
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS: N/A	

ANALYSIS SUMMARY:  

Right Knee Pain.  According to service treatment records (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI injured his right knee (“pop ... severe pain” while running) in November 2001.  He was treated conservatively until he reported a dislocation while on leave, and was ultimately diagnosed with a ruptured anterior cruciate ligament (ACL).  He underwent a surgical repair (allograft reconstruction) in October 2003 (13 months before separation).  There was intraoperative confirmation of ligamental stability in all planes after the repair.  There were numerous post-operative STR entries that confirmed stability to stress testing in all planes; and, although the CI used a brace after the surgery, the STR specified that it was for comfort.  Post-operative range of motion (ROM) measurements (after surgical recovery) documented flexion from 110 to 120 degrees (normal 140) and extension 0 degrees (normal).  The last orthopedic entry stated “full ROM with pain at end range.”  There was STR confirmation of the absence of effusion and no STR evidence of locking (no meniscal injury by MRI).   Surgical results were not sufficient to allow unrestricted duty and the CI was referred for an MEB, which in turn forwarded “chronic right knee pain status-post [ACL] reconstruction with quadriceps muscle atrophy” to the PEB.

The NARSUM examination on 13 July 2004 (4 months before separation) documented constant baseline pain rated 3/10 with exacerbations to 10/10 by “walking, stairs, bending, and load bearing.”  The physical examination recorded patellar tenderness and crepitus, quadriceps atrophy, stability to stress testing in all planes, and “full” ROM.

There was no VA claim, evaluation, or treatment; and, there was no other post-separation evidence in this case.

The Board directed attention to its rating recommendation based on the above evidence.  The PEB’s 10% rating under code 5099-5003 (analogous to degenerative arthritis) was aligned with VASRD §4.71a criteria for the service evidence.  There was no minimum compensable ROM limitation.  There was no persistent effusion and locking, or fracture with non-union or malunion, to achieve a rating higher than 10% under any applicable code; and, there was no evidence of instability for separate rating.  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 of the right knee condition.  

Contended PEB Conditions:  Chronic Left Knee Pain, Chronic Lower Back Pain.  The Board’s main charge was to assess the fairness of the PEB’s determinations that the above conditions were not unfitting.    These conditions were mentioned only in passing in the NARSUM, and there was no outpatient STR evidence of any clinical acuity for either of them during the MEB period.  Both were judged to meet retention standards; neither was profiled throughout service; and, the commander’s performance statement addressed only the right knee condition.  Members agreed that there was no performance-based evidence indicating that either of the above conditions interfered with duty requirements to an extent that would have prohibited further military service.  After due deliberation, and in consideration of the preponderance of the evidence, the Board concluded that there was insufficient cause to recommend a change in the PEB fitness determinations for left knee or lumbar conditions; thus, they were not eligible for Service rating.

BOARD FINDINGS:  In the matter of the right knee condition and IAW VASRD §4.71a, the Board unanimously recommends no change in the PEB adjudication.  In the matter of the contended left knee and lumbar conditions, the Board unanimously recommends no change from the PEB determinations as not unfitting.  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 20150609, with attachments
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

SAMR-RB						

MEMORANDUM FOR Commander, US Army Physical Disability Agency 
(AHRC-DO), 2900 Crystal Drive, Suite 300, Arlington, VA  22202-3557

20 MAR 2017

SUBJECT:  Department of Defense Physical Disability Board of Review Recommendation for 
XXXXXXXXXXXXXXXXXX, AR20170001936 (PD201501700)

I have reviewed the enclosed Department of Defense Physical Disability Board of Review (DoD PDBR) recommendation and record of proceedings pertaining to the subject individual.  Under the authority of Title 10, United States Code, section 1554a, I accept the Board’s recommendation and hereby deny the individual’s application. This decision is final. The individual concerned, counsel (if any), and any Members of Congress who have shown interest in this application have been notified of this decision by mail.

 BY ORDER OF THE SECRETARY OF THE ARMY:

Enclosure

CF: 
(  ) DoD PDBR
(  ) DVA