RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXX	CASE:  PD-2016-00670
BRANCH OF SERVICE:  ARMY	SEPARATION DATE:  20041225

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E3, Human Resources Administrative Specialist, medically separated for “chronic left knee pain" with a disability rating of 20%.  

CI CONTENTION:  He still has problems with his knee, and now has problems with his other knee and hip.  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 - 20041110	VARD - 20050927	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Left Knee Pain, following Meniscal Surgery and ACL Repair	5257	20%	Residuals of Left Knee Injury Status Post Anterior Cruciate Ligament Surgery, now with Degenerative Joint Disease	5299-5257	10%	20050411	
COMBINED RATING:  20%	COMBINED RATING OF ALL VA CONDITIONS:  10%	

ANALYSIS SUMMARY:  

Chronic Left Knee Pain.  According to the service treatment record (STR) and Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s chronic left knee pain condition began in September 1999 after a left anterior cruciate ligament (ACL) tear.  The CI underwent left ACL reconstruction with a patellar tendon autograft and subtotal medial and lateral meniscectomies in April 2000.  In August 2001 the CI twisted his left knee.  He underwent arthroscopy in January 2002 for a meniscal tear and a lateral meniscus repair in March 2002.  Magnetic resonance imaging (MRI) in October 2003 raised the question of the integrity of the ACL reconstruction graft, with a cyst noted in the region of the graft.  There was thinning of the tibiofemoral joint space cartilage and partial thickness oblique tears of the posterior horn of the lateral meniscus and the anterior horn of the medial meniscus as well as a possible radial tear of the peripheral of the posterior horn of the medial meniscus.  An MRI in January 2004 demonstrated a possible medial meniscal tear, which may have involved the anterior and/or posterior horn.  The CI underwent left knee arthroscopic medial meniscal repair and a partial lateral meniscectomy in April 2004.  Additionally, it was noted the ACL graft was attenuated and there was arthritis in all three compartments.  Following surgery, further treatment did not result in improvement sufficient to allow unrestricted duty.  

At the 22 June 2004 physical therapy clinic appointment, 11 weeks status after meniscal repair, the CI reported pain on a scale of 6-7/10) and denied locking or giving way.  On examination the left knee range of motion (ROM) was flexion to 130 degrees (normal 140) with pain occurring at 110 degrees.  There was mild to moderate laxity of the left ACL and McMurray’s test (to determine a meniscal tear) was positive.  In July 2004 the left knee ROM was 0 to 135 degrees with pain with terminal flexion and extension.  

The 29 October 2004 MEB NARSUM examination, 2 months prior to separation, noted complaints of slight and occasional pain that prevented the CI from climbing stairs and running, walking or standing for long periods of time.  Physical examination showed tenderness with a negative McMurray test and no varus or valgus instability.  ROM measurements for the left knee were not reported.  There was a 2A Lachman’s test (to determine laxity), an anterior drawer greater than 3 mm and less than 8 mm, with a positive glide on his pivot shift test, but no patellar grind or patellar apprehension, although he had some anterior medial-type knee pain with palpation.  

At the 11 April 2005 VA Compensation and Pension (C&P) evaluation, 4 months after separation, the CI reported pain aggravated by walking, prolonged standing and sitting, or climbing more than three stairs.  He complained of the knee giving way occasionally but denied locking.  He experienced a flare-up of knee pain three times a week, manifested by increased pain on a scale of 8-9/10 that required him to curtail his activities.  He denied use of any assistive devices and reported infrequent episodes of subluxation.  On examination the left knee ROM was flexion 110 degrees with mild pain occurring at 100 degrees. A 10 cm x 0.5 cm non-adherent, non-tender midline scar was present. Crepitus (grinding) with motion was noted and there was no effusion.  The CI had a normal gait.  The examiner reported minimal laxity of the ACL.  

The panel directed attention to its rating recommendation based on the above evidence. The PEB rated the left knee condition 20%, coded 5257 (knee, other impairment of:  recurrent subluxation or lateral instability: moderate), citing DoDI 1332.39, para E2.A1.1.15.2.2 which calls for a rating of 20% for moderate instability “in those cases where the Lachman’s test measures an instability reading of 2+ and physical therapy results in no improvement of the knee’s lateral instability.”  The VA rated the left knee condition 10%, coded 5299-5257 (knee, other impairment of: recurrent subluxation or lateral instability: moderate), based on the C&P examination 4 months after separation, citing minimal laxity in the ACL.  

There was no evidence of severe subluxation or lateral instability to support a 30% rating under the 5257 code.  There was no limitation of motion (5260, 5261) to support a rating under these 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) or ankylosis of the knee (5256).  No additional functional limitation was evidenced by the examinations.  Therefore, there is no VASRD §4.71a rating higher than the 20% 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 there was insufficient cause to recommend a change in the PEB 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 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 20160914, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

AR20170016916  , 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