RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME: XXXXXXXXXXXXXXXXXX	CASE:  PD-2017-02457
BRANCH OF SERVICE:  Army	SEPARATION DATE:  20061001

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E4, Cannon Crewmember, medically separated for “chronic right knee pain” with a disability rating of 10%.  

CI CONTENTION:  Review requested 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 - 20060901	VARD - 20070416	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Right Knee Pain…	5099-5003	10%	Patellofemoral Chondromalacia, Right Knee	5299-5259	10%*	20070103	
Posttraumatic Stress Disorder [PTSD] (Axis I-V)	Not Unfitting	PTSD	9411	30%	20070103	
Alcohol Abuse	Not Unfitting	No VA Placement	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  60%	
*VARD 20071001 assigned temporary 100% ratings from 20070416 to 20070601 and from 20070814 to 20071101 for two knee surgeries with return to a 10% rating.  

ANALYSIS SUMMARY:  

Chronic Right Knee Pain.  According to the service treatment record (STR) and MEB narrative summary (NARSUM), the CI underwent a right knee partial meniscectomy in December 2001 and was found at the time to also have an anterior cruciate ligament (ACL) deficient knee.  He had an ACL reconstruction in January 2002, using bone-tendon-bone autograft with bio-interference screw fixation in both the femoral and tibial tunnels.  In September 2002, he underwent an ACL revision reconstruction using allograft posterior tibialis tendon, and after continued pain over the proximal medial aspect of the right tibia, he had the tibial post screw removed In April 2006.  

The 18 May 2006 MEB NARSUM examination, 4 months prior to separation, noted CI complaints of right knee pain and instability.  Physical examination showed well-healed surgical incisions, and no effusion or medial/lateral joint line tenderness.   However, there was tenderness in a mild bursal formation surrounding the proximal medial tibial incision as well as along the patellar tendon.    Lachman’s, anterior and posterior, drawer, and meniscal provocative maneuver tests were all negative, and there was no evidence of varus or valgus instability.  Right knee range of motion (ROM) showed extension of 0 degrees (normal) and flexion of 120 degrees (normal 140) compared to the left uninjured side which revealed 0 degrees extension and 135 degrees flexion.  On 7 November 2006, X-rays revealed evidence of previous reconstructive orthopedic surgery in the right knee band, but was otherwise essentially negative.  
	
At the 3 January 2007 VA Compensation and Pension (C&P) examination, 3 months after separation, the CI reported pain, weakness, stiffness, swelling, instability and fatigability in his right knee.  He denied an unsteady gait or history of falls, and stated he used a cane and wore a brace when he walked longer distances, such as at the mall.  Physical examination showed a normal gait and no use of any ambulatory assistive devices.  He had pain over scars on the anterior knee and over the quadriceps muscle as well.  The scars were well-healed with no drainage or infection noted.  The examiner noted positive medial joint line pain, but no effusion or swelling.  There was anterior laxity noted during pivot shift testing, and greater than 5 mm of laxity with Lachman’s testing.  Drawer testing was positive anteriorly as well, but negative posteriorly, and McMurray’s testing was negative with no patellar grinding.  Crepitus was present and varus was negative while standing.  Right knee ROM showed hyperextension of -5 degrees and flexion of 140 degrees compared to the left uninjured side, which demonstrated hyperextension of -5 degrees and flexion of 150 degrees.  An MRI on the same day revealed a grossly intact posterior cruciate ligament with mild buckling and a possible mild anterior tibial translation; these indirect findings suggested possible ACL disruption.  VA records indicated the CI underwent right knee surgeries on 16 April 2007 and 14 August 2007 for a failed ACL reconstruction, with a treatment note on 13 September 2007 indicating full ROM and effusion.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the right knee condition 10%, analogously coded 5003 (arthritis, degenerative), citing moderate and frequent pain in accordance with the US Army Physical Disability Agency pain policy.  The VA also rated the right knee condition 10%, analogously coded 5259 (cartilage, semilunar, removal of, symptomatic), based on the STR and C&P examination, citing symptomatic removal of the semilunar cartilage, surgery performed on the right knee, and pain on motion.  The VA assigned temporary 100% ratings in April and August 2007 for two knee surgeries, with return to a 10% rating effective 1 November 2007 with the same coding.  Members agreed that while there was no limitation of flexion and extension which supported ratings under codes 5260 or 5261, the CI had persistent pain after meniscal surgery warranting a 10% rating under code 5259  (cartilage, semilunar, removal of symptomatic).  There was no history or evidence of dislocated meniscus or loose body causing frequent locking with recurrent effusions (5258), and 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 rating higher than the 10% adjudicated by the PEB 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.  

Contended PEB Conditions:  PTSD and Alcohol Abuse.  The panel’s main charge is to assess the fairness of the PEB determination that the contended conditions were not unfitting.  Neither of the conditions were profiled or implicated in the commander’s statement, and did not fail retention standards.  There was no performance-based evidence from the record that any of the conditions significantly interfered with satisfactory duty performance at separation.  After due deliberation, the panel concluded there was insufficient cause to recommend a change in the PEB fitness determination for any of the contended conditions, so no additional disability ratings are recommended.  

BOARD FINDINGS:  In the matter of the right knee condition and IAW VASRD §4.71a, the panel recommends no change in the PEB adjudication.  In the matter of the contended PTSD and alcohol abuse, the panel recommends no change from the PEB determinations as not unfitting.  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 20170307, w/atchs  
Exhibit B.  Service Treatment Record  
Exhibit C.  Department of Veterans Affairs Record  

AR20190007868, 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