RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2015-01804
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20070331

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E5, Power Generator Equipment Repair, medically separated for “chronic left knee pain,” with a disability rating of 10%.  

CI CONTENTION:  “Review all conditions.”  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 - 20070126	VARD - 20070926	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Left Knee Pain	5003	10%	Anterior Cruciate Ligament Tear…Post Surgery…Left Knee	5010-5260	10%	20070426	
			Shrapnel Injury, Left Thigh with Residual Scars	8699-8629	0%		
Mild Hyperlipidema	Not Unfitting	No VA Placement	
Overweight		No VA Placement	
Intermittent Right Knee Pain		Bursitis, Right Knee	5024-5260	10%	20070426	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  20%	

ANALYSIS SUMMARY:  

Chronic Left Knee Pain.  According to the service treatment record (STR), the Medical Evaluation Board (MEB) narrative summary (NARSUM), and MEB consultation summary, the CI’s left knee pain condition began in April 1998 while playing basketball.  He was initially treated with Motrin (anti-inflammatory medication).  Magnetic Resonance Imaging studies in April 2001 and June 2002 were suggestive of a complete anterior cruciate ligament (ACL) tear, possible posterior cruciate ligament (PCL) tear and lateral meniscus tear.  The CI underwent an autograft hamstring reconstruction of his ACL in June 2002.  In November 2002, the CI was given a Permanent L-2 Profile for his left knee to complete an alternate aerobic component of the Army physical fitness test (APFT).  The CI initially was able to pass alternative APFTs; however, the knee gradually became more painful.  Radiographic studies November 2006, showed post-surgical changes with evidence of early degenerative changes.  The CI was determined not to be a surgical candidate.  A permanent L-3 profile was issued and the CI was referred to a MEB.  The MEB forwarded “chronic left knee pain with tricompartmental degenerative arthritis, status post left ACL reconstruction” for PEB adjudication.  

At the 15 November 2006 MEB examination (recorded on DD Forms 2807-1 and 2808), 5 months prior to separation, the CI complained of knee pain, worse on the left, resulting in activity limitations.  Physical examination of the left knee demonstrated crepitus, full flexion/extension, and intact ligaments.  A limp was noted.  

The 27 November 2006 MEB consultation examination, 4 months prior to separation, noted complaints of throbbing left knee pain with most activities.  No instability was reported.  The CI reported inability to run, ruck or tolerate any significant weight on his back due to the knee pain.  Difficulty with stairs and other bent-knee activities was described.  Physical examination showed antalgic gait/stance, flexion at 90 degrees (normal 140), marked crepitus with range of motion in the patellofemoral joint, diffuse tenderness, normal alignment, and trace effusion.  The knee was stable to varus and valgus stresses (collateral ligament tests).  There was a negative Lachman (ACL test) and posterior drawer test (PCL). The patellar tracking and excursion were normal.  

The 14 December 2006 MEB NARSUM examination, 3 months prior to separation, noted complaints of throbbing left knee pain 50% of the time while awake, rated 7 to 8/10 along with occasional stiffness.  No significant swelling, instability or locking was reported.  Knee pain was aggravated by running, prolonged sitting, and kneeling.  The CI reported being able to walk unlimited, at his own pace.  Anti-inflammatory medication improved the knee pain.  Physical examination referenced the 27 November 2006 consultation above.  

At the 26 April 2007 VA Compensation and Pension (C&P) evaluation, performed 1 months after separation, the CI reported the left knee was stable.  Occasional wearing of a knee brace was reported.  Daily flares of mild pain was brought on by increased weight bearing or prolonged sitting.  The CI reported that he walked with a limp due to weakness of his left leg that he attributed to a previous shrapnel would of the left thigh.  Physical examination showed an antalgic gait, full extension, flexion.to 90 degrees and the limitation of motion was judged to be due to painful motion.  Drawer sign was negative, no instability or subluxation with varus or valgus stress was noted.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the left knee pain condition 10%, coded 5003 (arthritis, degenerative), citing pain and profile restriction.  The VA rated the left knee pain condition 10% analogously coded 5010-5260 (arthritis due to trauma -leg, limitation of flexion), based on the VA C&P examination 1 month after separation, citing limited range of motion due to pain.  There was no limitation of motion which supported a rating under the diagnostic codes for limitation of flexion or extension (5260, 5261).  However, there was evidence of painful motion with functional loss supporting a 10% rating (based on §4.59, §4.40 and §4.45) as adjudicated by the PEB.  There was, therefore, no VASRD §4.71a route to a rating higher than the 10% adjudicated by the PEB under any applicable code, and no grounds for additional rating based on the presence 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 for the left knee pain condition.  

Contended PEB Conditions:  Mild Hyperlipidemia, Overweight, Intermittent Right Knee Pain.  The panel’s main charge is to assess the fairness of the PEB’s determination that the contended conditions were not unfitting.  None of the conditions were profiled or implicated in the commander’s statement or judged to fail retention standards.  There was no performance-based evidence from the record that any of the conditions significantly interfered with satisfactory duty performance at separation.  After due deliberation, the Board concluded that there was insufficient cause to recommend a change in the PEB fitness determination for any of the contended conditions and so no additional disability ratings are recommended.  

BOARD FINDINGS:  
In the matter of the left knee condition and IAW VASRD §4.71a, the panel unanimously recommends no change in the PEB adjudication.  In the matter of the contended mild hyperlipidemia, overweight, and intermittent right knee conditions, the panel unanimously recommends no change from the PEB determinations as not unfitting.  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 20150609, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

AR20170009219, 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