RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXX	CASE:  PD-2016-01187
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20041022

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E6, Motor Transport Operator, medically separated for “left knee anterior cruciate ligament (ACL) deficiency” and “degenerative arthritis, right knee,” rated 10% each, respectively, with a combined disability rating of 20%.   

CI CONTENTION:  The CI made no specific contention.  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 at the time of separation.  The panel has neither the role nor the authority to compensate for progression or complications of service-connected conditions after separation.  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 - 20040928	VARD - 20050426	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Left Knee ACL Deficiency	5257	10%	Left Knee ACL Insufficiency	5259-5260	10%	20041110	
Degenerative Arthritis, Right Knee	5003	10%	Right Knee Degenerative Joint Disease	5010	10%		
COMBINED RATING:  20%	COMBINED RATING OF ALL VA CONDITIONS:  60%	

ANALYSIS SUMMARY:  

Left Knee Anterior Cruciate Ligament (ACL) Deficiency.  According to the service treatment record (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s left knee pain condition began while road marching during training for deployment in 2003.  There was evidence of left knee instability after that injury.  The CI underwent left knee surgery on 22 March 2004 for arthroscopy with subtotal lateral meniscectomy, there was no indication of an ACL repair during that procedure.  

At the 26 August 2004 MEB NARSUM examination, 2 months prior to separation, the CI reported bilateral knee pain and he was unable to run at all due to his left knee giving way.  Furthermore, the CI complained of constant pain in his left knee even when not running or jumping with an increase in that pain after standing for 10 minutes or walking for ½ mile.  Physical examination showed a positive drawer test, positive pivot shift, and a 1A Lachman’s (all are instability tests).  Range of motion (ROM) measurements showed flexion to 120 degrees (normal 140) and extension to 0 degrees (normal).  The examiner reported that a magnetic resonance imaging (MRI) showed an ACL tear and a meniscal tear.  Painful motion was not reported.  

At the 10 November 2004 VA Compensation and Pension (C&P) evaluation, 1 month after separation, the CI reported continued pain when climbing up and down from trucks.  Physical examination showed a normal gait.  ROM measurements showed flexion to 130 degrees and normal extension to 0 degrees.  McMurray’s sign was negative and the medial and lateral collateral ligaments were intact.  Painful motion was not reported though the CI was not able to squat due to bilateral knee pain.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the left knee condition 10%, coded 5257 (knee, other impairment of), citing not surgically repaired, with a 1A Lachman.  The VA also rated the left knee condition 10%, dual coded 5259-5260 (cartilage, semilunar, removal of, symptomatic-leg, limitation of flexion of).  There was no limitation of motion which supported a rating under the diagnostic codes for limitation of flexion or extension (5260, 5261).  The persistence of pain after meniscal surgery warranted a 10% rating under the 5259 code (cartilage, semilunar, removal of symptomatic).  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).  Additionally, there was evidence of left knee instability as adjudicated by the PEB for a 10% rating coded 5257.  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 left knee ACL deficiency condition, coded 5257 as adjudicated by the PEB and an additional 10% rating coded 5259 due to continued debilitating pain after partial removal of the semilunar cartilage of the left knee.  

Degenerative Arthritis, Right Knee.  According to the STR and the MEB NARSUM, the CI underwent right knee surgery in July 1999 for an ACL reconstruction, partial medial and lateral meniscectomy.  He underwent a second meniscus debridement 5 November 2001 due to increasing pain.  

A 26 December 2003 right knee MRI, 10 months prior to separation, reported a normal ACL, three compartment degenerative joint disease and near complete absence of the posterior horn of the medial meniscus.  At the 26 August 2004 MEB NARSUM examination, 2 months prior to separation, the CI reported bilateral knee pain.  Physical examination showed no effusion, negative tenderness to palpation, negative McMurray’s, negative patellar apprehension, negative drawer test, negative pivot shift, and a 1A Lachman.  ROM measurements showed flexion to 125 degrees (normal 140) and normal extension to 0 degrees (normal).  Painful motion was not reported.  

At the 10 November 2004 C&P evaluationthe CI reported slight discomfort on a daily basis in the morning with stiffness, also with cold, damp weather.  The CI also stated that stability had improved.  The examiner noted that the CI wore a knee brace.  Physical examination showed a normal gait and that he was unable to squat because of bilateral knee pain.  ROM measurements showed normal flexion to 140 degrees and normal extension to 0 degrees.  There was a positive anterior drawer sign and a positive Lachman test.  McMurray’s test was negative and the medial and lateral collateral ligaments were intact.  Painful motion was not reported.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the right knee condition 10%, coded 5003 (arthritis, degenerative), citing decreased ROM and surgical evidence of degeneration.  The VA also rated the right knee condition 10%, coded 5010 (arthritis, due to trauma, substantiated by X-ray findings).  There was no limitation of motion which supported a rating under the diagnostic codes for limitation of flexion or extension (5260, 5261).  The persistence of pain after meniscal surgery warranted a 10% rating under the 5259 code (cartilage, semilunar, removal of symptomatic) but panel members noted this did not constitute a rating advantage to the CI.  There was no history or evidence of dislocated meniscus or loose body causing frequent locking with recurrent effusions (5258) to support a rating under that code.  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 was therefore no VASRD §4.71a route to a rating higher than the 10% 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 adjudication for the degenerative arthritis, right knee condition.

BOARD FINDINGS:  In the matter of the left knee ACL deficiency condition the panel unanimously recommends a disability rating of 10%, coded 5257 as adjudicated by the PEB with an additional rating of 10% coded 5259 both IAW VASRD §4.71a.  In the matter of the degenerative arthritis, right 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 recommends that the CI’s prior determination be modified as follows; and, that the discharge with severance pay be re-characterized to reflect permanent disability retirement, effective as of the date of the prior medical separation:  

CONDITION	VASRD CODE	PERMANENT RATING	
Left Knee ACL Insufficiency, Not Surgically Repaired	5257	10%	
Left Knee Residual Pain After Partial Removal of the Lateral Meniscus	5259	10%	
Degenerative Arthritis, Right Knee	5003	10%	
COMBINED	30%	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20160916, w/attachments
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record 

AR20170018497, XXXXXXXXXXXXXXXXXXX

XXXXXXXXXXXXXXXXXXX

Dear XXXXXXXXXXXXXXXXXXX:

	I accept the recommendation of the Department of Defense Physical Disability Board of Review (DoD PDBR) to recharacterize your separation as a disability retirement with the combined disability rating of 30% effective the date of your medical separation for disability with severance pay.  Enclosed is a copy of the Board’s recommendation and record of proceedings for your information.

	The recharacterization of your separation as a disability retirement will result in an adjustment to your pay providing retirement pay from the date of your original medical separation minus the amount of severance pay you were previously paid at separation.
 
	The accepted DoD PDBR recommendation has been forwarded to the Army Physical Disability Agency for required correction of records and then to the U.S. Defense Finance and Accounting Service to make the necessary adjustment to your pay and allowances.  These agencies will provide you with official notification by mail as soon as the directed corrections have been made and will provide information on your retirement benefits.  Due to the large number of cases in process, please be advised that it may be several months before you receive notification that the corrections are completed and pay adjusted.  Inquiry concerning your correction of records should be addressed to the U.S. Army Physical Disability Agency, (AHRC-DO), 2900 Crystal Drive, Suite 300, Arlington, VA  22202-3557.

	A copy of this decision has also been provided to the Department of Veterans Affairs.

Sincerely,	
Enclosure