RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXX	CASE:  PD-2016-00776
BRANCH OF SERVICE:  Army	SEPARATION DATE:  20041115

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E5, Chaplain Assistant, medically separated for “chronic left knee pain status post anterior cruciate ligament [ACL] and lateral meniscus debridement” with a disability rating of 0%.

CI CONTENTION:  Current condition supports a higher rating.  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 - 20041006	VARD - 20051004	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Left Knee Pain…	5099-5003	0%	S/P Meniscal and ACL Repair Left Knee	5260	10%	20050106	
COMBINED RATING:  0%	COMBINED RATING OF ALL VA CONDITIONS:  20%	

ANALYSIS SUMMARY:

Chronic Left Knee Pain.  According to the service treatment record (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s left knee condition began in January 2001 following a twisting injury after a layup while playing basketball.  He underwent ACL reconstruction and lateral meniscus (semilunar cartilage) debridement (surgical excision of damaged, devitalized, or contaminated tissue) surgery in January 2001, and a second ACL reconstruction surgery in February 2003.  The 6 August 2004 MEB physical therapy examination, 3 months prior to separation, noted complaints of left knee pain and swelling when attempting the alternate physical fitness test.  Physical examination showed a gait within normal limits.  Instability testing was negative.  Range of motion (ROM) was flexion to 125 degrees (normal 140) and extension to 0 degrees (normal 0); painful was not addressed.  The 13 September 2004 MEB NARSUM examination, 2 months prior to separation, noted complaints of knee swelling and soreness with physical activity.  Physical examination showed a stable knee without effusion (fluid collection), but pain with patellar grind.  There was full ROM “with pain with extension to -2 degrees and flexion to 118 degrees.”

At the 6 January 2005 VA Compensation and Pension (C&P) evaluation, 2 months after separation, the CI reported daily left knee pain which was worse since the last surgery.  Physical examination showed no knee laxity but a positive McMurray’s (meniscus) test with apprehension, mild pain, and popping.  The ROM was flexion to 135 (140) degrees and extension to 5 (0) degrees with painful motion.

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the left knee pain condition 0%, analogously coded 5099-5003 (degenerative arthritis), citing degenerative arthritis without loss of joint motion.  The VA rated the left knee condition 10%, coded 5260 (leg, limitation of flexion), based on the C&P examination 2 months after separation, citing painful 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).  There was pain after meniscus debridement for consideration of a 10% rating under the 5259 code (cartilage, semilunar, removal of symptomatic).  However, more than one rating based on the same impairment (pain) is prohibited, IAW §4.14 (avoidance of pyramiding).  There was no evidence of slight subluxation or lateral instability to support a 10% rating under the 5257 code (knee, other impairment).  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).  After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the panel recommends a disability rating of 10% for the right knee condition, coded 5299-5260.

BOARD FINDINGS:  In the matter of the chronic left knee condition, the panel unanimously recommends a disability rating of 10%, coded 5260 IAW VASRD §4.71a.  There are no other conditions within the panel’s scope of review for consideration.  

The panel recommends that the CI’s prior determination be modified as follows, effective as of the date of the prior medical separation:

CONDITION	VASRD CODE	PERMANENT RATING	
Chronic Left Knee Pain	5299-5260	10%	

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 Records

AR20170017935, XXXXXXXXXXXXXXXXXXX

XXXXXXXXXXXXXXXXXXX

Dear XXXXXXXXXXXXXXXXXXX:

	The Department of Defense Physical Disability Board of Review (DoD PDBR) reviewed your application and found that your disability rating should be modified but not to the degree that would justify changing your separation for disability with severance pay to a permanent retirement with disability.  I have reviewed the Board’s recommendation and record of proceedings (copy enclosed) and I accept its recommendation.  This will not result in any change to your separation document or the amount of severance pay.  A copy of this decision will be filed with your Physical Evaluation Board records.  I regret that the facts of the case did not provide you with the outcome you may have desired.
  
	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 also been provided to the Department of Veterans Affairs.

Sincerely,	
Enclosure