RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXXX  	CASE:  PD-2017-00788
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20070112

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E3, Water Treatment Specialist, medically separated for “right knee pain, status post (S/P) lateral meniscectomy with partial anterior cruciate ligament (ACL) injury” with a disability rating of 10%.  

CI CONTENTION:  “Cannot move my knee in normal range.”  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 - 20061213	VARD - 20070504	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Right Knee Pain…	5259	10%	Residuals, Right Knee ACL Tear and Internal Derangement Lateral Meniscus	5260	10%	20070430	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  10%	

ANALYSIS SUMMARY:  

Right Knee Pain, S/P Lateral Meniscectomy.  According to the service treatment record and MEB narrative summary (NARSUM), the CI’s right knee condition began in May 2006 after falling to the ground during combatives training.  X-ray showed no evidence of fracture, dislocation or other abnormality.  MRI confirmed an ACL and meniscal tears.  He underwent right knee ACL reconstruction surgery in July 2006.  The 20 September 2006 orthopedic clinic appointment, 4 months prior to separation, noted complaints of chronic pain after surgery.  Physical examination showed right knee full range of motion (ROM).  A patella femoral grinding test demonstrated crepitus.  There was no effusion, swelling or erythema and the knee showed no deformity.  The examiner found no tenderness at the joint line, no hyperextension, and no laxity of the medial collateral ligament, ACL or the lateral collateral ligament.  There was no anterior drawer sign present and McMurray’s test (for meniscal tears) was negative.  

At the 2 October 2006 MEB physical therapy appointment , 3 months prior to separation, the examiner recorded right knee ROM measurements of flexion to 130 degrees (normal 140) and extension to 0 degrees (normal) after multiple repetitions.  During the 27 October 2006 MEB examination (recorded on DD Forms 2807-1 and 2808) the physical examination showed minimal decreased ROM with flexion and crepitus.  The same-day MEB NARSUM examination noted complaints of moderate and constant pain, an inability to kneel or squat and increased pain if the CI locked his knee. The examiner noted the CI wore a brace.  

At the 30 April 2007 VA Compensation and Pension (C&P) examination, 3 months after separation, the CI reported continued difficulty with his right knee anytime he had to stand for sustained periods of time.  Physical examination showed right knee flexion as 128 degrees with normal extension after multiple repetitions.  There was no marked tenderness over the right-side joint line.  McMurray’s and anterior and posterior drawer (for cruciate rupture) tests were negative.  Varus and valgus stress remained intact.  There was noted grimace and discomfort on the right side with patellar palpation.  He had an audible and palpable “clunk” on the right side with repetitive ROM.  Strength was 5/5 in the bilateral lower extremities and he did not have any atrophy in the quadriceps musculature.  There was no noted swelling, effusion, or marked laxity over the right knee.  Stance and coordination were all within normal limits with only mild antalgic gait on the right side.  The examiner noted the CI did not wear any mechanical aids during the examination but reported he wore a brace daily during exercise.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the right knee condition 10%, coded 5259 (cartilage, semilunar, removal of, symptomatic).  The VA rated the right knee condition 10%, coded 5260 (leg, limitation of flexion), based on the C&P examination, citing the condition more clearly approximated a compensable evaluation, based on objective evidence of pain on ROM under the provisions of 38 CFR 4.40.  The panel agreed there was no limitation of motion which supported a rating under the diagnostic codes for limitation of flexion or extension (5260, 5261). The 5259 code was applicable in this case band and the maximum 10% rating under that code was assigned.  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).  There was therefore no VASRD §4.71a higher rating under any applicable code.  After due deliberation, considering all 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 right knee 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.   

AR20190008809, 

Dear XXXXXXXXXXXXXXXX:

	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.