RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2016-01585
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20040319

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E1, Basic Trainee, medically separated for “left knee pain and mild instability” with a disability rating of 10%.   

CI CONTENTION:  “All pain is worse, able to do even less, general health suffering as result.”  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 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 - 20040302	VARD - 20050502	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Left Knee Pain…	5257	10%	Status Post Left Knee Anterior Cruciate Ligament Reconstruction and Lateral Meniscectomy to include Pain on Flexion	5260-5010	20%	20050207	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  60%	

ANALYSIS SUMMARY:  

Left Knee Pain.  According to the service treatment record and Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI underwent two surgical procedures on the left knee in 2003: an anterior cruciate ligament reconstruction in May and a lateral meniscectomy in December.  Following surgery, further treatment did not result in improvement sufficient to allow unrestricted duty.  

During the 26 January 2004 MEB NARSUM examination, 2 months prior to separation, the CI reported left knee pain.  Physical examination revealed near normal range of motion (ROM) with flexion to 130 degrees (normal 140).  Instability maneuvers were equivocal with some tests normal and others indicating minimal evidence of instability.  There was no effusion or grinding. 

At the 7 February 2005 VA Compensation and Pension (C&P) evaluation, 11 months after separation, the CI reported chronic, daily left knee pain with instability, and required a cane for ambulation.  Physical examination revealed global left knee tenderness and decreased, painful ROM with flexion to 110 degrees and extension to -10 degrees (normal 0).  Attempts at repetitive flexion and extension caused a subjective increase in pain and fatigability with prominent palpable crepitus.   

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), citing “mildly positive pivot shift, 1+ Lachman’s denote mild instability, range of motion remains full.”  The VA rated the left knee condition 20%, dual coded 5260-5010 (leg, limitation of flexion-arthritis, due to trauma), citing increased pain on use.  The MEB examination demonstrated a minimal presence of ligamentous instability (5257), and coupled with a history of surgery to remove a meniscus (5259), both codes were applicable in this case for 10% each.  There was no evidence of moderate or severe subluxation or lateral instability to support a 20% or 30% rating under 5257.  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).  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 left knee pain, coded 5259; and 10% for left knee instability, coded 5257, for a combined disability rating of 20%. 

BOARD FINDINGS:  In the matter of the left knee pain condition, the panel unanimously recommends a combined disability rating of 20%, coded 5257 and 5259 (10% each) IAW VASRD §4.71a.  There are no other conditions within the panel’s scope of review for consideration.  

The panel recommends 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	5259	10%	
Left Knee Instability 	5257	10%	
COMBINED	20%	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20161024, w/attachments
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record 

AR20180002274, 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