RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2016-01639
BRANCH OF SERVICE:  Army	SEPARATION DATE:  20040225

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E2, Trainee, medically separated for “chronic right knee pain status post anterior cruciate ligament [ACL] repair” with a disability rating of 0%.

CI CONTENTION:  The CI made no specific contention.  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 - 20040817	VARD - NA	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Right Knee Pain 	5099-5003	0%	No VA Examination Proximate to Separation in Evidence	
	COMBINED RATING OF ALL VA CONDITIONS:  NA	

ANALYSIS SUMMARY:

Chronic Right Knee Pain.  According to the service treatment record (STR) and Medical Evaluation Board (MEB) Narrative Summary (NARSUM), the CI underwent ACL reconstruction on 29 July 2003, but following the surgery developed retropatellar knee pain.  Radiographic imaging showed surgical changes.  The CI continued to report pain in the knee after prolonged sitting or standing, and going up and down stairs.  The 11 December 2003 physical therapy evaluation, 3 months before separation, revealed a normal gait.  Single leg squat test resulted in knee pain (painful motion).  The range of motion (ROM) was flexion to 140 degrees (normal) and extension to 0 degrees (normal).  

The 4 December 2003 MEB NARSUM, 3 months prior to separation, noted complaints of mild right knee pain graded 2-3/10, aggravated by activity.  She denied swelling or giving way of the knee, but noted some “popping.”  Physical examination showed a normal gait.  There was a small joint effusion and a positive patellar grind test, but no patellofemoral crepitus, patellar instability, maltracking or joint line tenderness.  There was a grade 1A Lachman (1 to 5mm of instability with a solid endpoint) indicating a slight stretch to the ACL ligament (normal after ACL repair) but no evidence of significant joint instability (negative pivot shift test).  Testing for meniscal pathology was negative.  Knee ROM was flexion to 140 degrees and extension to 0 degrees with painful motion present.  There was no VA examination proximate to separation in evidence.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the right knee condition 0%, analogously coded 5099-5003 (degenerative arthritis), citing full ROM without instability.  There was no limitation of motion which supported a rating under the diagnostic codes for limitation of flexion or extension (5260, 5261).  Following the ACL repair surgery, there was no evidence of significant knee instability for a rating under 5257 (knee, other impairment).  There was no history or evidence 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 those codes.  There was no fracture, nonunion 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 STR evidence of painful motion with functional loss 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 right knee condition, coded 5299-5260.

BOARD FINDINGS:  In the matter of the right knee condition, the panel unanimously recommends a disability rating of 10%, coded 5299-5260 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	
Chronic Right Knee Pain	5299-5260	10%	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20161025, w/atchs
Exhibit B.  Service Treatment Record

AR20180002648, 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