RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2017-02833
BRANCH OF SERVICE:  army	SEPARATION DATE:  20050422

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E3, Basic Trainee, medically separated for “left knee pain” with a disability rating of 10%.

CI CONTENTION:  “Knee pain and stiffness chronic.”  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 - 20050329	VARD - 20051121	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Left Knee Pain	5257	10%	Left Knee Anterior-Posterior Instability	5257	20%	20050808	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  30%	

ANALYSIS SUMMARY:

Chronic Left Knee Pain.  According to the MEB NARSUM and service treatment record the CI underwent left knee anterior cruciate ligament (ACL) surgery in September 2004 after twisting her knee during hand-to-hand combat training.  Physical therapy (PT) did not relieve the left knee pain.  X-rays revealed no gross left knee anomaly.  

At the 6 January 2005 MEB NARSUM examination, 4 months before separation, the CI reported concerns regarding her ability to complete the running portion of the physical fitness test.  The physician examiner reported, “No laxity with varus-valgus stress, negative Lachman's, negative anterior drawer, negative pivot shift.”  (Note:  The negative Lachman’s test, expanded later in the examination, was “1+ with a solid end point.”)  Left knee strength as measured in flexion and extension was 5/5 and neuro-vascularly intact.  Left knee range of motion (ROM) showed extension of 0 degrees (normal) and flexion of 120 degrees (normal 140) without pain.  Right knee (unaffected) ROM as a comparison was 0 degrees and flexion was 130 degrees.  

During the 25 February 2005 MEB examination (recorded on DD Forms 2807-1 and 2808), 2 months prior to separation, the CI reported she wore a knee brace.  Physical examination revealed pain with motion of the left knee.  The PT examination one week later noted complaints of occasional 3/10 pain.  ROM showed extension of 0 degrees and flexion of 128 degrees after three repetitions.  There was no report whether instability was present or not.  The examiner reported all motions with a firm end feel and no complaint of pain with the examination.

During the 8 August 2005 VA Compensation and Pension (C&P) examination, 4 months after separation, the physical examination showed a normal gait, no left knee crepitance, no meniscus impairment, and “moderate” instability.  Strength was 5/5 in all extremities and reflexes were 2+ bilaterally.  Left knee extension was 0 degrees and flexion was 140 degrees without pain.  There was no ROM loss following repetitive use.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the left knee condition 10%, coded 5257 (knee, other impairment), citing a 1+ Lachman’s (instability).  The VA rated the left knee condition 20%, also coded 5257, based on the C&P examination, citing “moderate” instability of the knee joint.  There was no evidence of painful motion with functional loss supporting a 10% rating (based on §§4.59, 4.40 and 4.45).  There likewise was no limitation of motion which attained a 10% rating under the diagnostic codes for limitation of flexion or extension (5260, 5261). There was no evidence of moderate knee disability. 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 recommends 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 20170315, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Record

AR20190007208, 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.