RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2015-01956
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20030822

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

CI CONTENTION:  The CI contends his condition continues to worsen.  The CI’s 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 - 20030731	VARD - 20040112	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Right Knee Pain…	5099-5003	10%	Rupture of ACL and Tear of Lateral Meniscus, Right	5299-5259	10%	20031028	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  10%	

ANALYSIS SUMMARY:  

Chronic Right Knee Pain.  According to service treatment records (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI underwent right knee surgery in April 2003 for torn anterior cruciate ligament (ACL) and partial lateral meniscectomy.  At a follow-up physical therapy 14 August 2003 the CI was still experiencing pain at a maximum level of 8/10.  The CI stated he experienced occasional sharp bursts of pain which subsides after approximately 5 minutes.  He stated standing also helped to ease the pain.  Examination showed a non-antalgic gait.  The range of motion (ROM) for flexion was 130 degrees (140 normal).  The CI had severe atrophy of his right quadriceps.  The examiner stated the prognosis for return to duty was poor and he was referred for MEB.  The MEB forwarded right knee pain status post ACL reconstruction and partial lateral meniscectomy for PEB adjudication.  The MEB NARSUM examination on 26 June 2003, 2 months prior to separation, noted complaints of severe pain despite conservative treatment which included physical therapy after surgery.  The pain interfered with his running, jumping, marching and other activities of basic training.  Physical examination showed ROM flexion of 135 degrees.  He had tenderness to palpation of the medial femoral condyle.  Tests for stability were negative.  He had severe muscle atrophy of his quadriceps of the right knee.  He was unable to complete the requirements of basic training.  At the 28 October 2003 VA Compensation and Pension (C&P) evaluation, performed 2 months after separation physical exam showed essentially normal flexion with recumbence to approximately 150 degrees.  Lachman and McMurray testing was normal.  He had a -30 degrees of flexion when standing as compared to his left knee.  

The Board directed attention to its rating recommendation based on the above evidence.  The PEB rated the right knee condition 10%, coded analogously 5099-5003 (degenerative arthritis) citing the US Army Physical Disability Agency pain policy.  The VA rated the right knee condition 10% coded analogously (cartilage, semilunar, removal of, symptomatic), based on the C&P examination 2 months after separation, citing limitation of forward flexion when standing.  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.  The examinations proximate to separation did not demonstrate the presence of ligamentous instability or laxity (5257), and there was no history of dislocated meniscus or loose body causing frequent locking with recurrent effusions (5258), to support a rating under the respective codes.  The 5259 code (cartilage, semilunar, removal of, symptomatic) was applicable in this case but the maximum 10% rating under that code provided no benefit to the CI.  There was no fracture, non-union, or malunion of the femur or tibia to support consideration under the respective codes for knee impairment related to long bone conditions (5255, 5262).  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 Board concluded that there was insufficient cause to recommend a change in the PEB adjudication for the right knee pain condition.

BOARD FINDINGS:  In the matter of the right knee pain condition and IAW VASRD §4.71a, the Board unanimously recommends no change in the PEB adjudication.  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 20150713, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

AR20170005297, 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,