RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2016-01551
BRANCH OF SERVICE:  ARMY 	SEPARATION DATE:  20040520

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E3, Food Service Specialist, medically separated for “torn right anterior cruciate ligament” with a disability rating of 20%.

CI CONTENTION:  The CI contends for his right knee condition.  The complete submission is at Exhibit A.  

SCOPE OF REVIEW:  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 - 20040430	VARD - 20041229	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Torn Right Anterior Cruciate Ligament	5257	20%	Anterior Cruciate Ligament Tear on the Right Knee	5257	20%	20040923	
COMBINED RATING:  20%	COMBINED RATING OF ALL VA CONDITIONS:  40%	

ANALYSIS SUMMARY:  

Torn Right Anterior Cruciate Ligament.  According to service treatment record (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI injured his right knee while in Basic Training after he jumped off of a wall in an obstacle course and landed wrong on his knee.  Radiographic (X-ray) studies of the knee were normal and a magnetic resonance imaging (MRI) showed a torn anterior cruciate ligament (ACL).  The CI was evaluated by orthopedic and was diagnosed with a torn ACL and recommended for surgery; however, the CI declined surgery.  At the MEB NARSUM examination on 20 February 2004, the CI complained of buckling and instability of his right knee with running and turning movements, and popping and cracking.  The examiner noted the CI was fitted with a knee brace that did improve his stability and the CI was not undergoing any medical treatment for his knee, nor was any treatment planned.  Physical examination showed generalized laxity over the knee, a positive pivot-shift test of the right knee and negative bilateral McMurray’s test.  Valgus-varus stress test was equal bilaterally and there was positive anterior drawer test of the right knee and a 2B Lachman’s test of the right knee.  There was no swelling or effusion.  Range of motion (ROM) measurements, conducted at physical therapy on 3 February 2004, showed right knee flexion of 130 degrees (normal 140) and an extension of -15 degrees (normal 0, hyper-extension).  For comparison, the left knee showed a flexion of 135 degrees and -15 degrees of extension.  The examiner also noted that X-rays were normal and an MRI showed a torn ACL on the right knee.  There was no evidence of arthritis mentioned on the examination.  The examiner stated, “This condition will not improve without surgery.  The service member declined surgical treatment for this condition.”

At the 23 September 2004 VA Compensation and Pension (C&P) evaluation, 4 months after separation, the CI reported constant pain with occasional swelling.  He reported his knee felt unstable, especially with running and he could no longer kneel or squat, and that his gait was normal except when he had been on his feet too long.  Physical examination showed that both knees had ROM measurements of normal flexion at 140 degrees and -15 extension.  The CI had significant anterior drawer motion, negative McMurray’s and positive Lachman’s sign.  There was no swelling, medial and lateral collateral ligaments appeared intact, there was no crepitus and the CI reported no major flare-ups of his knee.  The examiner noted that an X-ray on 23 September 2004 was normal with no evidence of arthritis mentioned.  It was also noted that the left knee was surprisingly hyper-extendable, the same as the right knee. 

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the right knee condition 20%, coded 5257 (knee, other impairment of; recurrent subluxation or lateral instability), citing required protective knee brace, full ROM with 2B Lachman’s, positive pivot shift and anterior drawer.  The VA also rated the right knee condition 20%, also coded 5257, citing recurrent subluxation or lateral instability of the knee, which was moderate.  There was no evidence of severe subluxation or lateral instability to support a 30% rating under the 5257 code (knee, other impairment of).  There was no path to a higher rating under any codes (5255, 5258, 5259, 5260, 5261 or 5262).  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 torn right anterior cruciate ligament condition.  

BOARD FINDINGS:  In the matter of the torn right anterior cruciate ligament 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.  Therefore, 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 20161019, w/attachments
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

AR20180004010, 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