RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXX	CASE:  PD-2015-02587
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20040923

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was a Reserve E4, Motor Transport Operator, medically separated for “pain in the left knee…” with a disability rating of 10%.

CI CONTENTION:  His knee condition continues to worsen and negatively impact other knee and 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 - 20040302	VARD - 20050407	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Pain in Left Knee…	5003	10%	Scarring and Early Minimal Degenerative Arthritic Changes, Residuals of the Anterior Cruciate Ligament Reconstruction, Left Knee	7805	0%	20050131	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  0%	

ANALYSIS SUMMARY:  

Pain in the Left Knee.  According to the service treatment record (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI injured his left knee while playing basketball in February 2003.  Serial clinical studies indicated instability of the anterior cruciate ligament (ACL) and the CI underwent a left ACL reconstruction in October 2003.  He reinjured the same knee after running in April 2004 and subsequently underwent a diagnostic arthroscopy in June 2004 which revealed an intact graph and evidence of synovitis and degenerative joint disease (DJD).  

At the MEB NARSUM, 4 August 2004, 2 months prior to separation, the CI’s chief complaint included locking, grinding, and give-way of the left knee.  His physical examination (PE) as performed on 11 May 2004 (4 months prior to separation) revealed an effusion and a flexed and fixed position of the left knee with a range between 15 and 100 degrees.  Guarding was present as well as a left-sided limp.  Altered sensation was present over the outside aspect of the lower left leg.  Clinical maneuvers to indicate stability were noted as “good”.  The examiner noted the CI’s prognosis as “fair” and “stable”.  At the 31 January 2005 VA Compensation and Pension (C&P) evaluation, 4 months after separation, the examiner recorded that the CI’s left knee was without symptoms.  His PE was detailed and completely normal.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the left knee condition 10%, coded 5003 (degenerative arthritis), citing “degenerative joint disease of a major joint confirmed by X-ray with limitation of motion, effusion and painful motion.”  The VA rated the left knee condition 0%, coded 7805 (scars), citing “a higher evaluation of 10 percent is not warranted unless the evidence shows a superficial scar that is painful on examination; or for an unstable, superficial scar; or unless leg extension is limited to 10 degrees; or unless flexion is limited to 45 degrees; or unless there is recurrent subluxation or lateral instability of the knee which is slight; or unless there is objective evidence of painful or limited motion of a major joint or group of minor joints, or multiple joint involvement.”

The panel members first agreed that both pre and post separation PE’s remained relevant as to probative value in determining an impairment rating.  Noting the initial fixed and flexed position of extension at 15 degrees during the NARSUM (equating to a 20% rating) was clearly improved to normal (0% rating) by the VA examination 8 months later.  No additional functional limitations were in evidence.  Pursuant to the above level of improvement, all panel members agreed that there existed no evidence applicable under other coding schemes to support an impairment rating greater than the PEB’s current 10%.  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’s adjudication for the left knee condition.

BOARD FINDINGS:  In the matter of the left knee 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 20151217, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

AR20170013337, 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