RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2017-00603
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20090727

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E5, Petroleum Supply Specialist, medically separated for “chronic left knee instability” with a disability rating of 20%.  

CI CONTENTION:  “I have constant pain in knee - VA will not help.  PTSD - went through therapy to help through VA.  Did not help.”  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 - 20090529	VARD - 20090928	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Left Knee Instability Post Surgery 4X with Degenerative Joint Disease and Chondromalacia Patella	5257	20%	Left Knee Instability, Residuals of Left Knee Anterior Cruciate Ligament/ Meniscal Tear with Degenerative Joint Disease	5257	20%	20090109	
COMBINED RATING:  20%	COMBINED RATING OF ALL VA CONDITIONS:  40%	

Chronic Left Knee Instability.  According to the service treatment record and MEB narrative summary (NARSUM), the CI’s left knee condition began in 1992 when he sustained a medial meniscus tear and medial collateral ligament injury while playing football, resulting in surgical repair.  In 2002, he twisted his knee and underwent an anterior cruciate ligament (ACL) reconstruction and partial meniscus removal.  He received a waiver to enlist in the Army in April 2006, as he was doing well, but in June 2006, while deployed to Iraq, he reinjured his knee while doing combative training, and a week later, twisted it while walking on rocky ground.  Magnetic resonance imaging showed tears of the medial and lateral menisci, and the CI underwent an arthroscopic debridement in August 2007.  Postoperatively he was doing well, until 2 months later, when he slipped on some gravel and reinjured his knee resulting in immediate pain and swelling.  On 25 April 2008, he underwent another knee debridement with hardware removal and ACL reconstruction.  Following surgery, his complaints of instability were greatly reduced, but he still had significant pain with many activities.  

At the 21 January 2009 VA Compensation and Pension (C&P) evaluation, 6 months before separation, the CI reported pain, weakness, stiffness, swelling and giving way of the left knee.  Physical examination showed normal gait with no edema, effusion, weakness, redness or guarding.  Range of motion (ROM) was flexion to 100 degrees (normal 140) with pain beginning at 90 degrees and extension to 0 degrees (normal).  There was slight anterior-posterior instability but side-to-side stability was normal.  Tests of the lateral and medial menisci were also “normal,” however, the examiner did not provide details for arriving at this conclusion.  

The 4 March 2009 MEB NARSUM examination, 4 months prior to separation, noted complaints of continued left knee pain with intermittent swelling.  Physical examination showed an antalgic gait, a 1+ Lachman’s (mild anterior-posterior instability) test, and pain with an indistinct endpoint on valgus stress at 15 degrees flexion (lateral instability).  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the left knee instability condition 20%, coded 5257 (knee, other impairment of), citing ROM and mild instability.  The VA rated the left knee instability condition 20%, coded 5257, based on the C&P examination, citing recurrent, moderate subluxation or lateral instability.  The VA provided an additional rating of 10% for the residuals of the ACL and meniscus tears with degenerative joint disease, coded 5260 (leg, limitation of flexion of), citing painful motion.  

It was noted that the PEB rated the knee condition 20% for instability with degenerative joint disease accounted for in the adjudication.  Members therefore concluded that consideration of dual coding for painful motion and instability was appropriate.  There was no limitation of motion, which supported a rating under the diagnostic codes for limitation of flexion or extension (5260, 5261).  However, there was evidence of painful motion with functional loss supporting a 10% rating (based on §4.59, §4.40 and §4.45).  The panel agreed that frequent locking due to dislocated semilunar cartilage was not present, and therefore a 20% rating was not justified under code 5258.  In deliberating a rating under code 5257 for degree of recurrent subluxation or lateral instability, members found the objective findings of instability by the C&P and NARSUM examiners were no more than mild, and agreed that the evidence most accurately described “slight” instability for a 10% rating.  However, the panel noted separate 10% ratings for painful motion and instability did not constitute a rating advantage to the CI.  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 left knee condition.  

BOARD FINDINGS:  In the matter of the chronic left knee instability condition 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 20170216, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Record 

AR20180006532, 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