PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2016-01412
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20040924

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E4, Medical Logistics Specialist, medically separated for “left knee pain” with a disability rating of 0%.   

CI CONTENTION:  Review his rating for unfitting knees and his not unfitting ear condition, and mentioned conditions not identified by either the MEB or PEB.  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 (VA), 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 -20040521	VARD - 20041215	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Left Knee Pain S/P ACL Reconstruction	5009-5003	0%	Osteoarthritis, Left Knee S/P …Reconstruction	5003	10%	20040730	
Sensorineural Hearing Loss in Left Ear	Not Unfitting	Otitis External, Left Ear	6210	10%	20040730	
COMBINED RATING:  0%	COMBINED RATING OF ALL VA CONDITIONS:  20%	

ANALYSIS SUMMARY:  

Left Knee Pain.  According to service treatment records (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s left knee condition began in January 2001 as he played basketball when he jumped and injured his left knee upon landing.  He was initially treated with crutches and a knee immobilizer.  X-rays of the left knee were normal in April 2001.  An MRI in June 2001 showed an anterior cruciate ligament (ACL) tear with bone bruise; no meniscal tear was identified.  On 18 September 2001 the CI underwent a left knee ACL reconstruction.  After surgery, while doing lunges, the CI reported he felt a “pop.” An orthopedist assessed the condition in March 2002 as retropatellar pain syndrome and recommended continued physical therapy. In October 2002 the CI had a 2+ Lachman test (to determine ACL laxity) and the assessment was a failed ACL reconstruction.  An MRI in April 2003 demonstrated no evidence of intra-articular disruption following reconstruction.  The ACL graft was grossly intact and there were no cartilaginous or ligamentous abnormalities of the knee.  On 22 April 2003, the CI underwent an ACL revision with a bone-patellar-tendon-bone graft.  Two months postoperatively flexion was 120 degrees (normal 140) and Lachman’s test was normal.  The CI had a full range of motion (ROM) in September 2003; however, knee pain persisted and a physical therapy note in October 2003 indicated a third surgery was scheduled in December 2003.  
 
During the 19 February 2004 MEB examination (recorded on DD Forms 2807 and 2808), 7 months prior to separation, the CI reported a swollen left knee and two surgeries.  Physical examination showed generalized tenderness, no edema, and a healed surgical scar.  A retropatellar grind was positive.  A slight click was detected at the lateral joint line during the McMurray’s test (to determine a meniscal tear), while a Lachman’s test was negative.  A minimal anterior drawer (to determine ACL laxity) was noted with a good end point.  Testing for valgus and varus laxity was negative.  The distal neurovascular examination was intact.  The 19 February 2004 MEB NARSUM examination, 7 months prior to separation, noted the complaint of constant left knee problems.  Physical examination reported the same findings as the MEB examination on the DD Form 2808.  X-ray studies the same day as the NARSUM examination noted post-operative changes of ACL reconstruction without abnormalities. Physical therapy ROM measurements on 4 March 2004 were 120 degrees flexion (normal 140) and 0 degrees extension (normal 0).  

At the 30 July 2004 VA Compensation and Pension (C&P) evaluation, 2 months before separation, the CI reported he continued pain and found it more comfortable to hold his knee at 15 degrees flexion.  He noted he was not able to stand or drive for long periods of time or run; however, the knee condition did not interfere with posture or gait.  Physical examination showed a normal gait and no heat, swelling, effusion, or tenderness of the left knee.  Deep tendon reflexes were within normal limits.  The drawer test and McMurray’s test were negative.  There was no evidence of subluxation or locking pain.  ROM measurements were flexion 15 to 100 degrees with pain and extension 15 to 0 degrees with pain. 

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the left knee condition 0%, coded analogously as 5003 (degenerative arthritis), citing no ligamentous laxity, full range of motion, and no neurological deficit.  The VA rated the left knee condition 10%, coded 5003 (degenerative arthritis), based on the C&P examination 2 months before separation, citing painful, limited motion of a major joint.

There was no limitation of flexion or extension that supported a rating under the VASRD diagnostic codes for limitation of motion (5260 or 5261), although VA measurements were based on the CI holding his knee at 15 degrees.  The examinations proximate to separation did not demonstrate the presence of ligamentous instability or laxity (5257), and there was no history of a dislocated meniscus or loose body causing frequent locking with recurrent effusions (5258) to support a rating under the respective codes.  There was no fracture, non-union, or malunion of the femur or tibia to support consideration under the respective codes for knee impairment related to long bone conditions (5255, 5262).  However, there was evidence of painful motion with functional loss at the VA C&P pre-separation examination thereby supporting a 10% rating (based on §4.59, §4.40 and §4.45).  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 condition, coded 5099-5003.  

Contended PEB Condition:  Sensorineural Hearing Loss in Left Ear.  The panel’s main charge is to assess the fairness of the PEB’s determination that the contended condition was not unfitting.  The contended condition was not profiled, implicated in the commander’s statement nor judged to fail retention standards.  There was no performance-based evidence from the record that the condition significantly interfered with satisfactory duty performance at separation.  After due deliberation, the panel concluded that there was insufficient cause to recommend a change in the PEB fitness determination for the contended condition and so no additional disability rating is recommended.    

BOARD FINDINGS:  In the matter of the left knee condition, the panel unanimously recommends a disability rating of 10%, coded 5003 IAW VASRD §4.71a.  In the matter of the contended sensorineural hearing loss condition, the panel unanimously recommends no change from the PEB determination as not unfitting.  There were 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	
Left Knee Pain	5099-5003	10%	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20161005, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

AR20180001582, 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