RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2017-01773
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20060202

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E5, Avenger Crewman, medically separated for “left knee pain following ACL reconstruction and medial meniscal debridement” with a disability rating of 20%.  

CI CONTENTION:  His knee 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 - 20060110	VARD - 20060223	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Left Knee Pain… 	5257	20%	Degenerative Joint Disease, Left Knee	5257	10%	20050829	
COMBINED RATING:  20%	COMBINED RATING OF ALL VA CONDITIONS:  10% 	

ANALYSIS SUMMARY:  

Left Knee Pain Following ACL Reconstruction and Medial Meniscal Debridement.  According to the service treatment record and MEB narrative summary (NARSUM), the CI underwent left knee surgery in May 2004 for anterior cruciate ligament (ACL) reconstruction and medial meniscal repair.  A repeat arthroscopy and medial meniscal debridement was conducted in December 2004 due to failed meniscal repair.  At the 11 March 2005 orthopedics appointment the CI complained of anterior knee pain as well as recurrent instability despite rest.  Range of motion was flexion of 135 degrees (normal 140) and extension of 0 degrees (normal 0).  Tenderness was noted at the inferior patellar pole.  There was minimal effusion and the knee was stable to varus/valgus stress and the knee exhibited a 2A Lachman with pivot glide.  At the 31 March 2005 orthopedic examination the CI complained of mild pain in the left knee with instability and giving way with activities of daily living (ADL) and pivoting.  The examiner noted there was no effusion.  ROM was flexion of 135 degrees and extension of 0 degrees.  Again the knee was stable to varus and valgus stress with a 2A Lachman and a positive pivot glide.  The medial structures tightened with external rotation and anterior drawer test.  The 29 August 2005 MEB NARSUM examination, 5 months prior to separation, noted complaints of continued pain in his knee.  His pain intensity was slight and pain frequency was occasional.  Physical examination showed a 1+ effusion in the left knee with ROM of 0-135 degrees.  The knee was stable to varus and valgus stress with a 2A Lachman and positive pivot glide.  Patellar grind was negative.  There was tenderness of the medial and lateral joint lines.  
At the 29 August 2005 VA Compensation and Pension (C&P) examination, 5 months before separation, the CI reported left knee pain with flare ups to 8/10.  Physical examination showed a normal gait.  Muscle strength was 5/5 (normal).  ROM was flexion of 140 degrees and extension of 0 degrees.  The examiner stated “Although the veteran did complain of knee pain, there is no change in range of motion with repetition.”  There was no swelling, joint effusion, or tenderness.    

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the left knee condition 20%, coded 5257 (knee, other impairment of).  The VA rated the left knee condition 10%, coded 5257, based on the NARSUM findings of ROM of 0-135 degrees, a 2A Lachman and positive pivot glide with tenderness and crepitus.  There was a history of surgery to remove a meniscus (5259) to justify a 10% rating.  There was evidence of slight subluxation to support a 10% rating under the 5257 code (knee, other impairment of) based on the NARSUM and C&P examinations.  There was no compensable limitation of motion (5260, 5261) and no history of dislocated meniscus or loose body causing frequent locking with recurrent effusions (5258) to support a rating under the respective codes.  There was no fracture, non-union, or malunion of the femur or tibia to support consideration under the respective codes for knee impairment related to long bone conditions (5255, 5262).  Although panel deliberations arrived at a 20% rating recommendation utilizing different coding options than the PEB, there is no rating benefit to the CI and therefore no change to the PEB’s coding choice is recommended.  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 left knee condition.    

BOARD FINDINGS:  In the matter of the left 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.  

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20170228, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Record

AR20180008641, 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