RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXX	CASE:  PD-2017-00250
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20041129

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects this covered individual (CI) was a National Guard E5, Light-Wheel Vehicle Mechanic, medically separated from the Temporary Disability Retired List (TDRL) for “chronic right knee instability” with a disability rating of 10%.   

CI CONTENTION:  “Discharged honorably after injured knee in Iraq, received no military benefits.” 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 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 - 20041109	VARD - 20040730	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Right Knee Instability	5257-5261	10%	Right Knee Hyperflexion Injury 	5257	30%	20040622	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  30%  	

ANALYSIS SUMMARY:  

Chronic Right Knee Instability.  According to the service treatment record and MEB narrative summary (NARSUM), the CI underwent right knee arthroscopy in 1990 and had an osteotomy in 1991.  However, the CI continued to have intermittent right knee pain.  Neuroimaging in 2001 showed a medial meniscus tear, chronic degeneration and osteophyte formation, as well as chronic degeneration of the anterior collateral ligament (ACL), medial collateral ligament (MCL) and possible lateral collateral ligament (LCL) tears.  While deployed in 2003, the CI fell and sustained a twisting hyperflexion injury.  The CI was separated and placed on TDRL on 5 November 2003.

At a 22 June 2004 VA Compensation and Pension (C&P) examination, 4 months before separation, the CI reported he was able to run but any kind of turning, cutting or pivoting was extremely painful.  He could climb stairs slowly and walk up to a mile.  He had mild pain and stiffness at his job as a truck driver, and could not play recreational sports.  Squatting was difficult and he was unable to kneel.  He denied locking but occasionally the right knee gave out.  There was pain extension unless supported by a pillow underneath.  Physical examination showed significant right valgus deformity of 16 cm measured by goniometry.  The right knee had greater than 5 mm mobility on anterior drawer testing and positive Lachman's.  There was significant valgus laxity associated with pain.  There was no indication of meniscal pathology or appreciable effusion.  Range of motion (ROM) testing of the right knee showed 4 degrees of extension (normal 0) and 130 degrees of flexion (normal 140), with a significant amount of pain at the extremes of extension.  The examiner noted the CI had a “significant disability” with decreased endurance with walking, inability to run, difficulty squatting, inability to kneel and occasional giving out of the right knee.  

The 18 October 2004 TDRL NARSUM examination, 1 month prior to separation, noted complaints of pain with walking greater than a half mile, running, jumping, stairs and other activities.  He denied instability.  Physical examination showed positive Lachman’s and pivot shift (knee instability).  There was internal tibial torsion, a large hard mass over the tibial tubercle consistent with Osgood Schlatter’s disease and a mild effusion.  Right knee ROM testing showed 10 degrees of extension and 120 degrees of flexion, after three repetitions.  X-rays showed patellofemoral and medial joint line chondromalacia.  The CI was diagnosed with degenerative joint disease with instability of the right knee and ACL and LCL tears.  The examiner noted there was “no way” the condition would improve.

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the right knee condition 10%, analogously coded 5257-5261 (other impairment of knee - limitation of extension of leg), citing slight instability and lack of 10 degrees from full extension.  The VA rated the right knee condition 30%, coded 5257 (other impairment of knee), based on the C&P examination, citing the severity of the condition and laxity on the examination. 
 
Panel members noted the TDRL NARSUM and C&P examinations identified residuals of pain and instability.  The NARSUM examination showed signs of limitation of extension that supported a rating of 10% under the VASRD diagnostic codes for limitation of extension (5261).  Both examinations acknowledged persistent pain and significant disability.  The C&P examination showed evidence of a significant degree of laxity associated with pain.  The TDRL NARSUM also acknowledged the presence of instability and noted limitations associated with pain and instability.  Members agreed the instability reflected a moderate degree of disability consistent with a 20% rating.  After due deliberation, considering all the evidence and mindful of VASRD §4.3 (reasonable doubt), the panel recommends a separation rating of 10% for loss of extension, coded 5261, and 20% for right knee instability, coded 5257, for a combined rating of 30%.  

BOARD FINDINGS:  In the matter of the right knee condition, the panel recommends a disability rating of 10%, coded 5261 IAW VASRD §4.71a for limitation of extension and a disability rating of 20% for instability, coded 5257 IAW VASRD §4.71a for a combined disability rating of 30%.  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; and, that the discharge with severance pay be re-characterized to reflect permanent disability retirement, effective the date of medical separation:  

CONDITION	VASRD CODE	PERMANENT RATING	
Chronic Right Knee Instability	5257	20%	
Right Knee Limitation of Extension 	5261	10%	
COMBINED	30%	

AR20200000288, XXXXXXXXXXXXXXXXX

Dear XXXXXXXXXXXXX:

I accept the recommendation of the Department of Defense Physical Disability Board of Review (DoD PDBR) to re-characterize your separation as a permanent disability retirement with the combined disability rating of 30% effective the date of your medical separation for disability with severance pay.  Enclosed is a copy of the Board’s recommendation and record of proceedings for your information.

	The re-characterization of your separation as a permanent disability retirement will result in an adjustment to your pay providing retirement pay from the date of your original medical separation minus the amount of severance pay you were previously paid at separation.
 
	The accepted DoD PDBR recommendation has been forwarded to the Army Physical Disability Agency for required correction of records and then to the U.S. Defense Finance and Accounting Service to make the necessary adjustment to your pay and allowances.  These agencies will provide you with official notification by mail as soon as the directed corrections have been made and will provide information on your retirement benefits.  Due to the large number of cases in process, please be advised that it may be several months before you receive notification that the corrections are completed and pay adjusted.  Inquiry concerning your correction of records should be addressed to the U.S. Army Physical Disability Agency, (AHRC-DO), 2900 Crystal Drive, Suite 300, Arlington, VA  22202-3557.

	A copy of this decision has also been provided to the Department of Veterans Affairs.