RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXX	CASE:  PD-2015-02179
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20030411

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty Reserve O3, Field Artillery Officer, medically separated for “chronic right knee pain” with a disability rating of 0%.

CI CONTENTION:  The CI’s conditions continue to worsen and negatively affect daily activities.  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 – 20030310	VARD-NA	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Pain Right Knee, Status Post Anterior Cruciate Ligament
Reconstruction with Right Patellofemoral Degenerative Joint Disease, Status Post Partial Lateral Meniscectomy	5099-5003	0%	No VA Exam in Evidence 	
COMBINED RATING:  0%	COMBINED RATING OF ALL VA CONDITIONS:  NA	

ANALYSIS SUMMARY:  

Chronic Right Knee Pain.  According to the service treatment record (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s right knee condition began in November 2001 when he injured it playing basketball during unit physical training.  He was diagnosed with right anterior cruciate ligament (ACL) and meniscus tears.  On 15 January 2002 the CI underwent a right knee arthroscopic ACL reconstruction with a hamstring tendon autograft (own tissue transplant).  Arthroscopy revealed a partial thickness lateral meniscus tear.  The 10 October 2002 right knee X-rays showed surgical changes from the ACL repair, no evidence of loose joint body, and early medial joint compartment osteoarthritis.  Despite physical therapy (PT) and rehabilitation, the CI eventually experienced severe right knee laxity while “jogging or doing other normal activities” which prevented him meeting the physical requirements of a field artillery officer.  The CI declined further surgery.  

The 16 December 2002 MEB NARSUM examination, 4 months prior to separation, noted complaints of “occasional slight” right knee pain with inability to participate in normal physical training, walk on uneven terrain, or carry more than 50 pounds.  The right knee examination revealed a healed incision, 1+ effusion (fluid collection), and patellofemoral joint tenderness with palpation and compression.  Right knee range of motion (ROM) was full (140 degrees flexion to 0 degrees extension normal) with 10 degrees of genu recurvatum (> 5 degrees knee hyperextension).  There was “hypersensitivity on full extension.”  The pivot shift test (assesses ACL) was positive.  The Lachman test (assesses ACL at 20-30 degrees flexion) was 1-A (Grade 1: < 5 mm – A = firm endpoint) and the anterior drawer (assesses ACL at 90 degrees flexion) was 2-A (Grade 2: = 5-10 mm – A = firm endpoint).  There was “slight grade 1 medial collateral ligament laxity with gapping to 5 mm at 0 degrees and 5 mm at 30 degrees.”  The X-rays revealed healed bone tunnels in adequate position.  The diagnoses listed right knee pain and instability secondary to failed ACL graft, patellofemoral degenerative joint disease, and partial lateral meniscectomy.

The 7 January 2003 MEB examination (recorded on DD Forms 2807-1 and 2808), 4 months prior to separation, recounted the right knee injury and surgery.  The examination noted negative effusion, Lachman and McMurray. Slight laxity with Drawer’s test was noted.  There was no VA Compensation and Pension (C&P) evaluation in evidence proximate to separation.

The panel directed attention to its rating recommendation based on the above evidence.  The PEB assigned a 0% rating under an analogous 5003 code (arthritis, degenerative) citing application of the U.S. Army Physical Disability Agency Policy, rated as slight and occasional.   Though the MEB NARSUM documented slight grade 1 medial collateral ligament laxity, the KT 1000 testing demonstrated translation equivalent to the uninjured knee.  While the CI underwent a partial lateral meniscectomy, there was no dislocated meniscus (5258) or symptomatic removed meniscus (5259) for consideration under the respective codes.  Though the MEB NARSUM documented hyperextension of 10 degrees, there was no genu recurvatum (5263) with weakness and insecurity in weight-bearing for consideration under the respective code.  The ROM values in the proximate examinations did not support a minimum rating under the limitation of knee flexion (5260) and extension (5261) codes.  There was no knee ankylosis (5256) or tibia and fibula nonunion/malunion (5262), for consideration under the respective codes.  The panel agreed a 10% rating was supported based on VASRD §4.59 (painful motion).  Panel members agreed that the instability more closely approximated the slight (10%) than the moderate (20%) rating under 5257 (knee, other impairment of).  After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the panel recommends a disability rating of 10% for the right knee condition, coded 5257.  

BOARD FINDINGS:  In the matter of the right knee condition, the panel unanimously recommends a disability rating of 10%, coded 5257 IAW VASRD §4.71a.  There are no other conditions within the panel’s scope of review for consideration.  

The panel recommends that the CI’s prior determination be modified as follows, effective as of the date of the prior medical separation:  

CONDITION	VASRD CODE	PERMANENT RATING	
Chronic Right Knee Pain	5257	10%	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20150610, with attachments
Exhibit B.  Service Treatment Record

AR20170010119, XXXXXXXXXXXXXXXXXXX

XXXXXXXXXXXXXXXXXXX

Dear XXXXXXXXXXXXXXXXXXX:

	The Department of Defense Physical Disability Board of Review (DoD PDBR) reviewed your application and found that your disability rating should be modified but not to the degree that would justify changing your separation for disability with severance pay to a permanent retirement with disability.  I have reviewed the Board’s recommendation and record of proceedings (copy enclosed) and I accept its recommendation.  This will not result in any change to your separation document or the amount of severance pay.  A copy of this decision will be filed with your Physical Evaluation Board records.  I regret that the facts of the case did not provide you with the outcome you may have desired.
  
	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. 

	A copy of this decision has also been provided to the Department of Veterans Affairs.

Sincerely,	
Enclosure