RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2017-02062
BRANCH OF SERVICE:  Army	SEPARATION DATE:  20050318

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E6, Infantryman, medically separated for “right knee pain and instability” with a disability rating of 20%.  

CI CONTENTION:  “Within 6 months after separation, the VA (after a full review of my medical condition) rated me at 60% combined.”  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 - 20041207	VARD - 20050520	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Right Knee Pain and Instability, Status Post ACL Reconstruction	5257	20%	Residuals of Constructive Surgery of the Anterior Cruciate Ligament, Right Knee with Degenerative Joint Disease	5003-5257	20%	20050315	
COMBINED RATING:  20%	COMBINED RATING OF ALL VA CONDITIONS:  30%	

ANALYSIS SUMMARY:  

Right Knee Pain and Instability.  According to the service treatment record (STR) and MEB narrative summary (NARSUM), the CI underwent right knee meniscal debridement and anterior cruciate ligament (ACL) reconstruction surgery in February 2001 due to a remote sports related injury.  His surgical recovery was uncomplicated and eventually he was able to deploy.  While deployed, he reinjured the right knee in August 2003 after jumping off a military training vehicle.  An MRI performed in June 2004 was consistent with partial and complete tears of the proximal and mid portion of the ACL with degenerative joint changes.  Continuation of aggressive physical therapy (PT) did not relieve his painful symptoms.  

During the 8 September 2004 MEB examination (recorded on DD Forms 2807-1 and 2808), 6 months prior to separation, the CI reported pain and locking of the right knee.  His physical examination (PE) revealed full range of motion (ROM) of the right knee without tenderness, swelling, or instability.  The 10 November 2004 MEB NARSUM examination, 4 months prior to separation, noted complaints of aching pain within his right knee.  The PE revealed ROM of normal extension and decreased flexion of 130 degrees (normal 140).  There was trace joint effusion, surrounding muscular atrophy, and local tenderness, and clinical tests consistent with ligament disruption (instability).  

At the 15 March 2005 VA Compensation and Pension (C&P) examination, 3 days prior to separation, the CI reported continued right knee pain that was aggravated with prolonged walking and any impact activity like running, jumping, or road marching.  The PE revealed a normal gait and normal flexion of the right knee.  Extension was not quantified, but “pain and tenderness” was present with such movement.  Repetitive motion did cause pain and “…reduction in the ROM,” but this was also not quantified.  Local swelling was present as well as “marked wasting” (atrophy) of the right quadriceps muscle.  Instability maneuvering tests were positive, indicating joint instability.  The examiner noted the CI was not using a brace.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the right knee condition 20%, coded 5257 (knee, other impairment of: recurrent subluxation or lateral instability), citing moderate instability IAW DODI 1332.39 Para E2.A1.1.15.2.2.  The VA rated the right knee condition 20%, dual coded 5003-5257 (arthritis, degenerative- knee, other impairment of: recurrent subluxation or lateral instability), based on the STR and C&P examination, citing recurrent subluxation or lateral instability of the knee which is moderate.  

Panel members first agreed that the greatest degree of probative value be apportioned to the VA examination due to its close proximity to separation.  There was no 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 these respective codes.  There was no fracture, nonunion, or malunion of the femur or tibia to support consideration under the codes for knee impairment related to long bone conditions (5255, 5262).  However, there was a history of meniscal (cartilage) debridement/removal which supported a 10% rating under VASRD code 5259.  Panel members further agreed that the positive clinical tests performed at the probative examination supported a degree of joint instability ratable under VASRD code 5257.  The rating levels for 5257 are tiered at “slight” (10%), “moderate” (20%), and “severe” (30%).  The panel’s task was to determine the appropriate impairment level under 5257 for combination with 5259.  

The panel concluded that, despite the “marked wasting” of the right quadriceps muscle (function = flexion of the knee), the maintenance of normal knee flexion coupled with a normal gait and lack of a requirement to wear an external brace indicates minimal weakness of the lower extremity and thus corresponds to “slight” instability impairment at 10%.  Therefore, the panel recommends a disability rating of 10% for the right knee pain condition coded 5259, and an additional 10% for right knee instability coded 5257.  However, this provides no benefit to the CI greater than the 20% adjudicated by the PEB.  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.  

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20170223, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Record

AR, 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