RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2015-01874
BRANCH OF SERVICE:  Army  	SEPARATION DATE:  20050217

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an National Guard E4, Infantryman, medically separated for “chronic left knee pain,” with a disability rating of 0%.  

CI CONTENTION:  The CI requested a review of 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 - 20050113	VARD - 20090527	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Left Knee Pain…	5099-5003	0%	PCL Tear, Status Post Lateral Meniscal Repair and Partial Medial Meniscectomy	5299-5260	NSC	20090514	
COMBINED RATING:  0%	COMBINED RATING OF ALL VA CONDITIONS:  NA	

ANALYSIS SUMMARY:  

Chronic Left Knee Injury.  According to service treatment records (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI injured his left knee in high school when struck by a car while he was riding a bicycle.  An MRI showed internal knee derangement and he was taken to surgery on 13 August 1998.  There a medial meniscus (an internal cartilage cushion) tear (MMT) and lateral meniscus tear (LMT) were repaired.  In addition, damage was noted to both the anterior and posterior cruciate ligaments (ACL and PCL) which provide anterior and posterior stability to the knee.  These were also repaired.  A 2+ posterior drawer’s test of the PCL was noted at surgery.  This persisted on post-surgical follow-up.  The knee was stable though.  This was declared at accession and the CI was cleared by orthopedics for enlistment.  The CI had no problems with training or duty until he reinjured his knee while running on 7 July 2004.  He was noted to have a positive posterior drawers.  In a civilian clinic on 30 September 2004, the knee pain was reported as fully resolved and he had returned to jogging.  The examination of the knee was normal other than a positive anterior and posterior drawer’s sign.  He was thought to have a resolved left knee sprain and cleared to return to duty.  However, the CI was no longer confident that his knee (could meet full duty requirements) and he was entered into the MEB process.  The MEB NARSUM examination, dated 1 December 2004, 2 months prior to separation, noted unable to perform expected duties.  There were no complaints of locking or giving way. CI stated he was “no longer confident of his knee.”  The physical examination was unremarkable other than surgical scars and a positive posterior drawer test, which had been present on multiple examinations since the surgery in 1998.  The range of motion (ROM) was normal.  There was no VA examination in evidence proximate to separation.

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the “chronic left knee pain” condition 0%, coded analogous as 5003 (degenerative arthritis), citing degenerative arthritis without significant loss of joint motion.  The VA, based on an examination remote from separation, determined that the knee condition was not service connected (NSC) as there was no evidence of permanent aggravation beyond normal progression (since the initial injury).  There was no evidence of painful motion with functional loss supporting a 10% rating (based on §4.59, §4.40 and §4.45).  There likewise was no limitation of motion, meniscal pathology, or instability to support a minimum rating under the diagnostic codes 5260, 5261, 5257, 5258, 5255, or 5262.  Therefore the panel concluded there was not sufficient evidence to support a rating higher than the 0% adjudicated by the PEB.  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 “chronic left knee pain” condition.  

BOARD FINDINGS:  In the matter of the “chronic left 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 modification or re-characterization of the CI’s disability and separation determination.  

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20150703, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record 

AR20170009229, 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