RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2017-00029
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20040414

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E3, Microwave Operations Maintainer, medically separated for “ACL [anterior cruciate ligament] deficient right knee” with a disability rating of 20%.  

CI CONTENTION:  No specific contention was made.  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 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 - 20040319	VARD - 20040427	
Condition	Code	Rating	Condition	Code	Rating	Exam	
ACL Deficient Right Knee	5257	20%	Instability… Right Knee	5257	10%	STR	
			Limitation of Motion… Right Knee	5260	10%	STR	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  20% 	

ANALYSIS SUMMARY:  

ACL Deficient Right Knee.  According to the service treatment record (STR) and MEB narrative summary (NARSUM), the CI injured his right knee in November 2002 while running an obstacle course.  He underwent right knee surgery in April 2003 for a torn ACL, and operative findings noted “some wear” of the menisci, but that they were stable.  An MRI (not in evidence) also indicated degeneration of the medial meniscus.  The CI did well in rehabilitation although he reported pain with squatting or running.  On 21 January 2004, he was noted to have a good endpoint of the ACL with full motion and strength.  However, in February 2004 he tore the ACL graft, and an MRI also showed that part of the medial meniscus was absent.  He reasonably declined a repeat reconstruction.
 
During the 23 February 2004 MEB NARSUM orthopedic examination, approximately 11 months post-surgery and 2 months prior to separation, the CI reported occasional pain, an inability to run, and that his right knee would give out with activities of daily living.  On examination, he stood, sat, and walked “well” (implying a normal gait), and there was no effusion or tenderness.  The range of motion (ROM) was documented as “-5-130/0-135,” with no explanation about whether these values represented right/normal, right/left, or active/passive ROM; painful motion was not recorded.  Lachman’s and pivot shift tests for instability were both 2+, but there was no mention of an endpoint.  In the 8 March 2004 MEB NARSUM addendum, the same orthopedist, who had also done the surgery, referred to an X-ray showing degenerative joint disease, and an MRI indicating medial meniscus injury as well as cartilage degeneration.  The orthopedist also noted that the examination was “unimproved from prior to the surgery,” but details were not recorded.  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 20%, coded 5257 (knee, other impairment of: recurrent subluxation or lateral instability, moderate), citing 2+ Lachman’s pivot shift test results.  The VA rated the right knee condition 10%, coded 5257, based on the STR, citing evidence of positive instability tests.  The VA also rated the knee 10%, coded 5260 (limitation in flexion), for painful and limited motion.  Members noted that multiple VASRD knee codes are allowed for limitations in flexion, extension, and instability, however the NARSUM ROM measurements did not support a compensable rating under code 5260 (flexion) or 5261 (extension).  Painful motion was also not recorded to support a rating under code 5003 (degenerative arthritis).  The panel deliberated whether the CI had a “slight” or “moderate” disability under code 5257, and noted that while he was not able to run and reported “giving way” with the activities of daily living, he was observed to walk, sit, and stand well, implying good function.  This was thought to be more consistent with a slight impairment, as adjudicated by the VA, but the panel does not recommend a combined rating lower than that adjudicated by the PEB.  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 ACL deficient right knee and IAW VASRD §4.71a, the panel 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 20161217, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Record

AR20180009929, 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