RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX
	CASE:  PD-2015-01750
BRANCH OF SERVICE:  Army	SEPARATION DATE:  20030206

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E5, AH-64 Attack Helicopter Repairer, medically separated for “chronic right knee pain status post anterior cruciate ligament rupture reconstruction” with a disability rating of 10%.

CI CONTENTION:  The CI contends that the VA granted a higher rating for the same condition.  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 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 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 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 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 – 20021018	VARD – 20030211	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Right Knee Pain…ACL Reconstruction	5099-5003	10%	…ACL Reconstruction, Right Knee	5010-5259	10%	20021223	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  20%	

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 August 1996 while playing racquet ball.  On 13 December 1996, the CI underwent right knee diagnostic arthroscopy which revealed a partial anterior cruciate ligament (ACL) tear, medial meniscus bucket-handle tear, and chondromalacia patella (pathologic patellar articular cartilage changes).  The surgeon performed a partial medial meniscectomy (meniscus surgical excision).  On 20 February 1997 the CI underwent an endoscopic ACL reconstruction with a bone-tendon-bone allograft (cadaver tissue transplant).  Because of lateral joint line pain, and a prominent and painful tibial screw, he elected to undergo diagnostic arthroscopy.  On 26 March 1998, the CI underwent right knee arthroscopy, meniscal tear debridement, and tibial screw removal.  Because of increasing instability and persistent swelling, on 24 July 2000 the CI underwent a right ACL reconstruction revision with an ipsilateral hamstring autograft (own tissue transplant).  At the 21 February 2002 orthopedic surgery evaluation the CI complained of pain over the proximal tibial screw with pressure.  The right knee examination revealed a tender prominence at the proximal medial tibia and no joint line tenderness.  Active range of motion (ROM) was flexion of 130 degrees (140 normal) and extension of 0 degrees (0 normal).  The Lachman test (assesses ACL) was 1+ (less than 5mm translation) with a firm end point.  The McMurray test (assesses menisci) was negative.  On 9 April 2002 orthopedic surgery excised a right knee symptomatic suture knot.  

The 24 September 2002 MEB NARSUM examination, 5 months prior to separation, noted complaints of right knee pain after walking 6 to 7 blocks, stairs, marching, jumping, or running.  He noted the inability to climb into aircraft or bend down to perform aircraft maintenance.  The right knee examination revealed well-healed incisional scars and mild joint line tenderness.  The patella was stable and there was no evidence of joint instability.  Active ROM was flexion of 130 degrees and extension of 0 degrees.  The McMurray test was positive with pain.  The anterior drawer test (assesses ACL) was negative and the Lachman test was 1+.  Right knee X-rays revealed minimal degenerative changes, good alignment, and no prominent hardware.  

The 23 December 2002 VA Compensation and Pension (C&P) examination, 2 months prior to separation, documented an antalgic gait (assuming a gait or posture to lessen pain) favoring the left lower extremity while guarding the right.  The right knee examination revealed multiple well-healed arthroscopic scars with no tenderness, tissue loss, or adherence to underlying structures.  There was lateral joint line tenderness with no effusion (fluid collection), swelling, or ligamentous instability.  Pain-limited active ROM was flexion of 130 degrees and extension of 0 degrees.  Pain and fatigability was noted with repetitive use.  There was decreased sensation to light touch over the lateral aspect secondary to surgical residuals.  Right knee X-rays revealed ACL reconstruction with normal components position and alignment and no evidence of fracture, dislocation, or complication.

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the right knee 10%, analogously coded 5099-5003 (degenerative arthritis), citing the US Army Physical Disability Agency’s pain policy for slight and frequent pain.  The VA rated the right knee condition 10%, coded 5010-5259 (traumatic degenerative arthritis-cartilage, semilunar [meniscus], removal of, symptomatic) based on the VA C&P examination 2 months before separation, citing painful motion.  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 partial medial meniscectomy, and anterior meniscal tear debridement, there was no dislocated meniscus (5258) or symptomatic removed meniscus (5259) for consideration under the respective codes.  There was no knee ankylosis (5256), knee recurrent subluxation/lateral instability (5257), tibia and fibula nonunion/malunion (5262), or genu recurvatum (5263) for consideration under the respective codes.  The panel agreed a 10% rating was supported based on VASRD §4.40 and §4.59 (for functional loss due to painful motion).  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 for the right knee condition.  

BOARD FINDINGS:  In the matter of the chronic right knee pain condition and IAW VASRD §4.71a, the panel unanimously recommends no change in the PEB adjudication.  There were no other conditions within the panel’s scope of review for consideration.  The panel, 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 20150701, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

AR20170008788, 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