RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2016-01524
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20040604 

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects this covered individual (CI) was a Reserves W3, Pilot, medically separated for “right knee pain” with a disability rating of 10%.   

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 - 20040305	VARD - 20040812	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Right Knee Pain	5257	10%	Residuals, Arthroscopy and Thermal Shrinkage Right Anterior Cruciate Ligament (ACL)	5257	10%	20040506	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  20%	

ANALYSIS SUMMARY:  

Chronic Right Knee Pain.  According to the service treatment record and Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI underwent arthroscopy in July 2002, which showed mild chondromalacia of the patella and laxity of the ACL, but no meniscal tears.  The CI then had a thermal shrinking procedure to tighten the ACL.  Postoperative physical therapy did not relieve the knee pain and further surgery was declined.  

The 17 December 2003 MEB NARSUM examination, 6 months prior to separation, noted complaints of intermittent pain with ruck marching and inability to resume running.  Physical examination showed full range of motion (ROM) of the right knee.  The knee was stable to varus and valgus stress, but had a 1+ anterior Lachman (test for ACL injury/laxity).  A posterior drawer test (to determine posterior cruciate ligament rupture) was negative.

At the 6 May 2004 VA Compensation and Pension (C&P) evaluation, 1 month before separation, the CI reported no pain or physical impairment.  Physical examination showed normal gait and station.  ROM measurements were extension of 0 degrees (normal) and flexion of 140 degrees (normal).  A slightly positive Lachman at 1+ was noted.  McMurray’s test (to determine the presence of a meniscal tear) was negative.  No medial or lateral laxity at 0-30 degrees of flexion was noted.  At an orthopedic visit on 28 September 2005, 15 months post-separation, the CI was assessed as having a normal right knee status post injury and surgery.  The orthopedic surgeon opined he saw “no reason the CI could not perform physical activities of any kind, and he certainly could return to full active duty military.”  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the right knee condition 10%, coded 5257 (knee, other impairment of), citing persistent pain with a 1+ Lachman.  The VA also rated the right knee condition 10%, coded 5257, based on the C&P examination 1 month before separation, citing full ROM with 1+ Lachman but no pivot shift.  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) as adjudicated by the PEB. The examinations proximate to separation did not demonstrate the presence of significant ligamentous instability or laxity (5257) beyond a slight level, and there was no history of dislocated meniscus or loose body causing frequent locking with recurrent effusions (5258), or history of surgery to remove a meniscus (5259) to support a rating under the respective codes.  There was therefore no VASRD §4.71a 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 there was insufficient cause to recommend a change in the PEB adjudication for the right knee condition.  

BOARD FINDINGS:  In the matter of the 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 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 20161017, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record 

AR20180001647, 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