RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2016-00282
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20020916

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E5, Signal Support Systems Specialist, medically separated for “chronic pain, left knee, due to chondromalacia, with partial tear anterior cruciate ligament status post reconstruction” with a disability rating of 10%.  

CI CONTENTION:  “I was pushed out of the Army and left to deal with service connected medical issues on my own.”  The CI’s complete submission is at Exhibit A.  

SCOPE OF REVIEW:  The Board’s scope of review is defined in DoDI 6040.44.  It is limited 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.  Any conditions outside the Board’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 Board’s authority is limited to assessing the fairness and accuracy of PEB rating determinations and recommending corrections, where appropriate.  The Board’s assessment of the PEB rating determinations 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 at the time of separation.  The Board 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 Board 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 - 20020522	VARD - 20020927	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Pain, Left Knee, Due to Chondromalacia, with Partial Tear Anterior Cruciate Ligament	5099-5003	10%	Residuals of Arthroscopic Surgery, Left Knee, with Chondromalacia, Partial Tear of Reconstructed Anterior Cruciate Ligament	5099-5020	10%	20020814	
RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  30%	

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 began in January 1989, prior to his enlistment, after he injured his knee playing soccer and underwent anterior cruciate ligament (ACL) reconstructive surgery.  He injured his knee again in January 2001 while running in sand.  Arthroscopic surgery was performed in May 2001, but further treatment did not result in improvement sufficient to allow unrestricted duty.  

The 19 April 2002 MEB NARSUM examination, 5 months prior to separation, noted complaints of persistent left knee pain which had increased following his arthroscopy.  Physical examination showed well healed incisions on both sides of the knee, with mild crepitus and tenderness to palpation.  There was no ligamentous laxity and meniscal signs were absent.  Radiographs demonstrated a small tibial spur on the anterior surface.  There were no complaints of locking or giving way.  The range of motion (ROM) was mildly limited in flexion.  At the 14 August 2002 VA Compensation and Pension (C&P) evaluation, performed 1 month before separation, the CI reported left knee pain present on a daily and constant basis, most painful when climbing stairs, standing for extended lengths of time, or when running or walking long distances.  Physical examination showed an antalgic gait with tenderness to palpation but no effusion or swelling.  Crepitus with motion was noted but there was no ligament instability and no pain on motion.  

The Board 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 the US Army Physical Disability Agency (USAPDA) pain policy rating of slight/frequent.  The VA rated the chronic left knee pain condition 10% coded 5099-5020 (analogous to synovitis), based on the VA C&P examination 1 month before separation, citing recurring knee pain and findings of slight limitation of motion.  

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 examinations proximate to separation did not demonstrate the presence of ligamentous instability or laxity (5257), and there was no history of dislocated meniscus or loose body causing frequent locking with recurrent effusions (5258), or history of surgery to remove a meniscus (5259) to support a rating under the respective codes..  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 chronic 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 re-characterization of the CI’s disability and separation determination.  

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20160516, with attachments
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

AR20170014149, 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,					      
						      					
Enclosure