RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2016-01258
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20040607

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E4, Infantryman, medically separated for “anterior cruciate ligament (ACL) deficiency right knee” with a disability rating of 10%.  

CI CONTENTION:  He contends his knee condition.  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 Medical Evaluation Board (MEB), but determined by the PEB 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.  The panel’s authority is limited to assessing the fairness and accuracy of PEB rating determinations and recommending corrections when appropriate.  The panel’s assessment of the PEB rating determination is based on review of medical records and all available evidence relevant to application of the Veterans Affairs Schedule for Rating Disabilities (VASRD) standards for 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, which operates 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 disability at the time of separation.  

RATING COMPARISON:  

SERVICE PEB - 20040330	VARD - 20040708	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Anterior Cruciate Ligament Deficiency Right Knee	5257	10%	Status Post ACL Reconstruction, Right Knee	5257	10%	20040330	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  10% 	

ANALYSIS SUMMARY:  

Anterior Cruciate Ligament Deficiency Right Knee.  According to the service treatment record (STR) and the MEB narrative summary (NARSUM), the CI’s knee condition began in February 2001 after a twisting injury.  The CI underwent three right knee surgeries (April, July and August 2001) including debridement, ACL surgical reconstruction, and debridement following wound infection.  The CI regained his range of motion (ROM) and had minimal stability problems; however, he had problems with quadriceps muscle (anterior thigh) atrophy and chronic knee pain.  

During the 21 January 2004 MEB examination (recorded on DD Forms 2807-1 and 2808), 12 months prior to separation, the CI reported a right knee injury with surgeries and chronic pain.  Physical examination showed right knee with decreased strength.  The 2 February 2004 MEB NARSUM examination, 4 months prior to separation, noted complaints of right knee pain.  Limitations included no running, no road marching, and crunch sit-ups only.  X-rays showed surgical changes, and the CI was taking a nonsteroidal anti-inflammatory medication for knee pain.  Physical examination showed bilateral knee ROM of 0-130 degrees (normal 140).  There was right side quadriceps atrophy measuring 5 cm less than the opposite side.  Strength was normal (5/5).  The right knee scars were well healed and there was joint line, and harvest cite, tenderness without signs of effusion.  There was a 1A Lachman and 1+ anterior drawer, with no collateral ligament laxity.  Distal neurologic and vascular examination was normal.  

At the 30 April 2004 VA Compensation and Pension (C&P) evaluation, 1 month before separation, the CI reported right knee aching, swelling, and buckling.  Functional impairment was inability to run or walk for long periods of time.  Physical examination showed normal posture and gait.  The examiner found right knee slight instability on abnormal drawer and McMurray’s tests.  Right knee ROM was 0-110 degrees with the original examination documenting no pain; however, the addendum (from the same day) stated “flexion is limited by pain but is not additionally limited by fatigue, weakness, lack of endurance or coordination.”  Remote VA evidence indicated the CI underwent a second ACL reconstruction on 28 November 2006 (25 months after separation).  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the knee condition 10%, coded 5257 (knee, other impairment of: recurrent subluxation or lateral instability), citing Lachman’s grade 1A.  The VA also rated the knee condition 10% coded 5257, based on the C&P examination 1 month before separation, citing no pain on motion and slight instability.  There was no greater than slight laxity for any rating higher than 10% under code 5257 on any examination.  However, rating under code 5257 does not include painful motion IAW VASRD §4.59.  The STR documented the CI’s predominant complaints and duty limitations were of right knee pain with gastrocnemius atrophy.  The pre-separation VA examination with addendum (which was closest to separation and included DeLuca criteria) had the highest probative value for rating and documented painful motion warranting 10% for painful motion and dual rating of the knee.  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 ACL deficiency condition, coded 5257 with the addition of a 10% rating coded 5099-5021 (myositis).  

BOARD FINDINGS:  In the matter of the right knee ACL deficiency condition, the panel unanimously recommends a disability rating of 10%, coded 5257 plus a 10% rating coded 5099-5021, both 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	
Anterior Cruciate Ligament Deficiency Right Knee	5257	10%	
	5099-5021	10%	
COMBINED	20%	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20160923, w/attachments
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record 

AR20180002710, XXXXXXXXXXXXXXXXXX

XXXXXXXXXXXXXXXXXX

Dear XXXXXXXXXXXXXXXXXX:

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