RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2016-00769
BRANCH OF SERVICE:  ARMY	SEPARATION DATE:  20040723

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was a Guard E5, Supply Specialist, medically separated for “osteoarthritis, left knee status post ACL reconstruction and meniscal surgery” with a disability rating of 20%.   

CI CONTENTION:  “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 - 20040421	VARD - 20041118	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Osteoarthritis Left Knee S/P ACL Reconstruction and Meniscal Surgery	5003	20%	S/P Anterior Cruciate Ligament Repair; Degenerative Joint Disease, Left Knee	5010-5262	10%	20040913	
			Medial Laxity, Left Knee	5257	10%	20040913	
COMBINED RATING:  20%	COMBINED RATING OF ALL VA CONDITIONS:  50%	

ANALYSIS SUMMARY:

Left Knee Osteoarthritis.  According to the service treatment record (STR) and the MEB narrative summary (NARSUM), the CI’s left knee condition began in February 2002 pursuant to a sport related injury.  An extensive surgical history included two partial removals of the left meniscus in May 2002 and January 2003.  In July 2003 he underwent a left anterior cruciate ligament (ACL) reconstruction.  At the time of the orthopedic appointment on 9 January 2004, the examiner recorded normal knee range of motion (ROM) without evidence of instability.  

The 12 February 2004 MEB examination (recorded on DD Forms 2807-1 and 2808), 5 months prior to separation, the CI reported the inability to climb stairs.  Physical examination indicated “minimal swelling, ROM within normal”.  The MEB NARSUM examination, conducted on the same day, noted complaints of an inability to do regular physical training exercises or perform a crawl.  Physical examination revealed no evidence of swelling of the left knee.  There was not muscle atrophy of the lower extremities.  Left knee ROM was flexion to 105 degrees (normal 140) and extension was 0 degrees (normal 0) with painful motion present.  

At the 13 September 2004 VA Compensation and Pension (C&P) evaluation, 2 months after separation, the CI reported continued discomfort in his left leg.  Physical examination revealed a normal gait.  The left knee showed a “slight” medial laxity and “moderate” medial quadriceps atrophy.  Meniscal testing was negative.  ROM was flexion to 110 degrees and extension was 0 degrees; painful motion was not addressed.  X-rays indicated mild degenerative joint disease with postsurgical changes.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the left knee condition 20%, coded 5003 (degenerative arthritis), citing osteoarthritis requiring the use of a brace and occasional incapacitating exacerbations.  The VA rated the left knee condition 10%, analogously coded 5010-5262 (degenerative arthritis due to trauma-tibia and fibula impairment), citing slight functional loss as evidenced by limitation of motion due to pain and quadriceps atrophy.  The VA also rated left knee medial laxity at 10%, coded 5257 (knee, other impairment), citing slight lateral instability.  The panel agreed there was no limitation of motion which supported a rating under the diagnostic codes for limitation of flexion or extension (5260, 5261) proximate to separation.  However, there was evidence of painful motion with functional loss supporting a 10% rating (based on §4.59, §4.40 and §4.45) as reported by the MEB NARSUM and other STR examinations.  There was a persistence of pain after meniscal surgery to warrant a 10% rating under the 5259 code (cartilage, semilunar, removal of symptomatic).  However, the Board concluded that this pain symptom was already a component of the painful motion criteria noted above and if applied again would be considered pyramiding IAW §4.14 (avoidance of pyramiding).  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).  There is no VASRD §4.71a route to a 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 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 osteoarthritis 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.  Therefore, the panel recommends 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 20160913, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

AR20180005746, 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