RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2016-00257
BRANCH OF SERVICE:  army 	SEPARATION DATE:  20070705

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E5, Intelligence Analyst, medically separated for “right knee pain” with a disability rating of 20%.  

CI CONTENTION:  “Please review 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 - 20070517	VARD - 20071226	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Right Knee Pain 	5257	20%	Internal Derangement Right Knee	5257	0%	20071207	
COMBINED RATING:  20%	COMBINED RATING OF ALL VA CONDITIONS:  0%	

ANALYSIS SUMMARY:  

Right Knee Pain.  According to the service treatment record (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the right knee condition began in October 2002 while wrestling.  Radiographic imaging in February 2005 documented tears of the medial meniscus (MMT) and anterior cruciate ligament (ACL), along with an osteochondral defect of the medical femoral condyle.  The CI declined surgery.  

At the 28 February 2007 MEB orthopedic NARSUM examination, 4 months before separation, the CI reported pain aggravated by jumping, running, stair climbing, squatting, hiking and ruck marching with inability to run, change directions rapidly, and negotiate uneven terrain due to instability.  The physical examination showed full ROM, anterior-posterior laxity (indicative of ACL tear), with evidence of meniscal tear.  There was no evidence of patellofemoral arthritis, effusion, or medial or lateral instability.  

At the 30 April 2007 MEB examination (recorded on DD Form 2808), 2 months prior to separation, the physical examination showed medial joint line tenderness with “moderate” anterior-posterior laxity.  The 30 April 2007 MEB NARSUM addendum documented ROM of 0-115 degrees (normal 0-140) and pain with flexion.  There was also anterior–posterior laxity noted.  

The 6 November 2007 VA Compensation and Pension (C&P) general medical examination, 4 months after separation, showed a normal gait and full ROM with no evidence of muscle atrophy, effusion, or laxity.  At the 7 December 2007 orthopedic VA C&P evaluation, performed 5 months after separation, the CI reported pain after prolonged use and a decreased ability to work out.  She denied any impact on her daily activities and denied recent flare ups.  The physical examination showed a normal gait, full ROM without pain, and no swelling.  After attaching a 2 pound weight to the ankle, the CI could fully extend the knee 6 times without pain, weakness, fatigue, or lack of endurance.  The medial and lateral ligaments were intact and “slight movement” (approximately 0.5 cm translation) noted with anterior-posterior laxity testing.  

The panel directed attention to the rating recommendation based on the above evidence.  The PEB rated the right knee condition 20%, coded 5257 (knee, other impairment of:  recurrent subluxation or lateral instability), citing radiographic evidence of ACL rupture and meniscal tear.  The VA rated the right knee condition 0%, coded 5257, citing no evidence of recurrent subluxation or lateral instability.  

There was no evidence of severe subluxation or lateral instability to support a higher 30% rating under the 5257 code.  There was no compensable limitation of motion (5260, 5261), no history of surgery to remove a meniscus (5259), and no history of dislocated meniscus or loose body causing frequent locking with recurrent effusions (5258) to support a rating higher than the 20% PEB rating.  Finally, 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).  No additional functional limitation was evidenced by the examinations.  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 right knee condition.  

BOARD FINDINGS:  In the matter of the right knee condition 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 re-characterization of the CI’s disability and separation determination.  

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20160420, w/attachments
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

AR20170015196, 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.

	A copy of this decision has been provided to the counsel you listed on your application, XXXXXXXXXXXXXXXXXX
Sincerely,					      
						      					
Enclosure