RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXX	CASE:  PD-2015-02454
BRANCH OF SERVICE:  ARMY 	SEPARATION DATE:  20060316

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E2, Basic Trainee, medically separated for “left knee pain with a history of an injury …” with a disability rating of 10%.  

CI CONTENTION:  The CI requests the panel consider 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 - 20060224	VARD - NA	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Left Knee Pain … 	5099-5003	10%	No VA Exam in Evidence	
COMBINED RATING: 10%	COMBINED RATING OF ALL VA CONDITIONS:  NA	

ANALYSIS SUMMARY:  

Left Knee Pain.  According to service treatment records (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI underwent left knee surgery in December 2005 (4 months prior to separation) for left anterior cruciate ligament (ACL) and medial meniscal tear with hamstring ACL reconstruction.  Following surgery further treatment did not result in improvement sufficient to allow completion of basic training.  

During the January 2006 MEB examination (recorded on DD Forms 2807-1 and 2808), 2months prior to separation, the CI reported left knee swelling since the initial injury in October 2004 and that she wore a locking leg brace and used a cane for ambulation.  Physical examination for the lower extremities was checked as “abnormal” stating “left ACL repair s/p (status post) repair.”  The CI’s memo from 26 January 2006 stated that the CI could not twist or pivot and that there was popping of the knee with activity.  

The 30 January 2006 MEB NARSUM examination, 6 weeks prior to separation, noted complaints of daily constant left knee pain knee along the hamstrings and retropatellar area.  The pain interfered with sleep and prevented her from running, jumping and marching.  Physical examination of the left knee showed well healed surgical incisions with intact light touch sensation, except for an area of decreased sensation along the anterolateral aspect of the leg.  Skin was normal with no effusion, no distal edema and no joint line tenderness.  Lachman’s test (of ACL integrity) was noted as grade 1A (no more than 5mm; with a firm endpoint).  Range of motion (ROM) testing recorded 135 degrees flexion (140 normal) and 0 degrees extension (normal).  There was no VA Compensation and Pension (C&P) evaluation in evidence.  

The panel directed attention to its rating recommendation based on the above evidence.  

The PEB rated the left knee pain 10%, coded 5003 (arthritis, degenerative (hypertrophic or osteoarthritis)), citing the US Army Physical Disability Agency pain policy.  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 analogous 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 as that coding includes painful motion.  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 panel concluded that there was insufficient cause to recommend a change in the PEB adjudication for the left knee pain.  

BOARD FINDINGS:  In the matter of the left knee pain 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 20151015, with attachments
Exhibit B.  Service Treatment Record

AR20170013177, XXXXXXXXXXXXXXXXXXX

XXXXXXXXXXXXXXXXXXX

Dear XXXXXXXXXXXXXXXXXXX

	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