RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2015-02217
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20060822

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

CI CONTENTION:  The CI contends for his unfitting left knee, that it continues to worsen and negatively impact daily activities.  He also contends for conditions not identified by either the MEB or PEB.  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 - 20060629	VARD - 20070214	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Left Knee Pain	5009-5003	10%	Medial Meniscal Tear, Left Knee, With Residual Chronic Pain	5260	10%	20061229	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  30%	

ANALYSIS SUMMARY:  

Chronic Left Knee Pain.  According to the service treatment record (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s chronic left knee pain condition began in 1996.  Prior to entering the Army the CI underwent an anterior cruciate ligament (ACL), posterior cruciate ligament (PCL) and medial collateral ligament (MCL) reconstruction as well as a partial removal of the medial meniscus.  In January 2006, he then injured his knee again while running PT.  Radiographic studies in January 2006 (plain film X-rays) showed post-surgical changes associated with the ACL repair, retained hardware from the MCL repair and minimal degenerative changes.  A magnetic resonance imaging (MRI) study on 27 March 2006, 5 months prior to separation, was hampered by artifact from the retained metallic surgical hardware from the previous operation; however, the radiologist was able to comment that the ACL, PCL and MCL were intact.  The orthopedic surgeon observed that there was increased signal in the posterior horn of the medial meniscus suspicious for a new medial meniscus injury.  The CI was offered an arthroscopic evaluation with possible meniscal repair which he declined.  

At the 15 May 2006 MEB NARSUM examination, 3 months before separation, the CI reported constant dull achy pain, mostly at the anterior aspect of his knee.  It was aggravated by running, jumping exercises or impact activity, repetitive squatting, marching or ruck marching, going up stairs, walking for greater than 30 minutes without a chance to sit down and stretch and wearing body armor.  On examination there was tenderness.  His pain was mildly exacerbated with a McMurray test (for meniscus injury).  He had pain with patellar grind.  Crepitus with motion was noted.  Left knee range of motion (ROM) was flexion of 135 degrees (normal 140) and extension of 0 degrees (normal).  

At the 29 December 2006 VA Compensation and Pension (C&P) evaluation, 4 months after separation, the CI reported wearing a brace for his knee.  He no longer played sports and weight bearing activities caused an increase in pain.  Physical examination showed there was a limping gait.  Left knee ROM was flexion of 120 degrees (normal 140) and extension of 0 degrees (normal).  There was tenderness along the medial joint line and an effusion.  There were no complaints of painful motion.  There was no additional limitation of function with repetition due to fatigue, pain, weakness or lack of endurance. 

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the chronic left knee pain condition 10%, coded 5099-5003 (analogous to degenerative arthritis), citing application of the US Army Physical Disability Agency (USAPDA) pain policy.  The VA rated the left knee condition 10%, coded 5260 (limitation of flexion), citing painful motion.  

There was no limitation of motion which supported a rating under the diagnostic codes for limitation of flexion or extension (5260, 5261).  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.  There was no fracture, nonunion 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. 

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.

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 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 20150808, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

AR20170012128, XXXXXXXXXXXXXXXXXX

XXXXXXXXXXXXXXXXXX

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,