RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2017-01456
BRANCH OF SERVICE:  Army	SEPARATION DATE:  20050506

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects this covered individual (CI) was a National Guard E4, Chemical Operations Specialist, medically separated for “chronic left knee pain and instability” with a disability rating of 10%.  

CI CONTENTION:  His condition continues to worsen and negatively impact daily activities.  He also requested review of additional conditions not identified by the Medical Evaluation Board (MEB) and Physical Evaluation Board (PEB).  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 PEB to be unfitting for continued military service, and when specifically requested by the CI, those conditions identified by the 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 - 20050414	VARD -NA	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Left Knee Pain and Instability	5099-5003	10%	No VA Examination Proximate to Separation in Evidence	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  NA	

ANALYSIS SUMMARY:  

Chronic Left Knee Pain and Instability.  According to the service treatment record and MEB narrative summary (NARSUM), the CI’s left knee pain began in October 2003 after he tripped on a curb while running.  He was treated conservatively until March 2004, when a diagnostic arthroscopy revealed torn anterior and posterior cruciate ligaments (ACL/PCL).  He underwent ACL reconstruction in July 2004 and PCL reconstruction in September 2004 with a revision in October 2004.  Despite physical therapy, he required the use of a brace for instability, and a potential third surgery was not expected to improve his condition to meet full duty requirements.  

During the 31 December 2004 orthopedic follow-up visit, 5 months prior to separation, the CI reported he was doing well overall, but still had instability.  Physical examination showed left knee range of motion (ROM) “near full and symmetric” compared to the right, with “very good” quadricep and hamstring strength.  While anterior drawer and Lachman tests revealed a stable knee, the provider noted slight laxity with posterior drawer testing with a stable end point.  Posterior sag sign was negative and had significantly improved compared to pre-surgery tests.  The CI was issued a brace for instability.  

The 15 March 2005 MEB NARSUM examination, 2 months prior to separation, noted complaints of left knee instability with constant pain rated at 5/10; and intermittent, sharp pain rated at 8-9/10, which lasted half a day and occurred about 5 days a week.  The pain was aggravated by running, crawling, bending, and squatting.  The CI wore a knee brace for instability, and had problems getting in and out of a tub, going up and down stairs, and doing activities with his children.  Physical examination revealed a normal gait with was no tenderness, effusion, erythema, or induration.   Drawer and Lachman’s test were positive for instability, and there was left quadricep atrophy with decreased girth; pivot-shift and lateral instability stress tests were negative.  Left knee ROM measurements showed flexion to 130 degrees (normal 140) and extension to 0 degrees (normal), with no mention of painful motion.

At a physical therapy appointment on 1 April 2005, 1 month before separation, the CI reported knee pain and instability.  Physical examination revealed full ROM with no instability while wearing the brace, but giving way without the brace.  Gait was within normal limits with no effusion, and the examiner documented a positive 1A Lachman’s test but negative pivot shift.  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 left knee pain condition 10%, analogously coded 5099-5003 (arthritis, degenerative), citing some loss of joint motion.  Members noted there was no limitation of flexion or extension that supported a higher rating under VASRD diagnostic codes 5256, 5260, or 5261.  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); and no evidence of painful motion with functional loss supporting a 10% rating (based on §4.59, §4.40 and §4.45).  The panel agreed there was evidence of slight knee instability warranting a 10% rating using code 5257 (knee, recurrent subluxation), as reported by the orthopedic and NARSUM examinations proximate to separation.  However, changing the PEB coding would result in no benefit 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 pain 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 20170220, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Record 

AR20180010934, 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