RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2017-03617
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20070305

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E3, Food Service Specialist, medically separated for “chronic left knee pain” with a disability rating of 20%.   

CI CONTENTION:  His knee and ankle conditions have worsened and he 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 - 20061207	VARD - 20070831	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Left Knee Pain	5257	20%	Left Knee Condition	5010	10%	20070515	
Chronic Left Ankle Pain	Not Unfitting	Residuals, Left Ankle Injury	5271	0%		
COMBINED RATING:  20%	COMBINED RATING OF ALL VA CONDITIONS:  10%	

ANALYSIS SUMMARY:  

Chronic Left Knee Pain.  According to the service treatment record and MEB narrative summary (NARSUM), the CI underwent left anterior cruciate ligament (ACL) knee surgery in September 2000 and required a waiver to join the Army in July 2004.  The CI’s left knee condition became aggravated during combative training in May 2005 after a twisting injury.  X-ray studies performed in July 2006 showed good post-surgical placement without evidence of degenerative changes.  

During the 28 August 2006 MEB examination (recorded on DD Forms 2807-1 and 2808), 7 months prior to separation, the CI reported that his left knee has been locking, giving out, and painful after strenuous activity since May 2005.  His physical examination (PE) revealed full range of motion (ROM) of the left knee with a slight effusion.  Clinical maneuvering tests for instability were negative.  Clinical testing for meniscal pathology could not be performed due to pain and guarding.  The CI was able to toe and heel walk.  There were no gait abnormalities reported.  

At the 20 September 2006 orthopedic MEB NARSUM, 7 months prior to separation, the CI endorsed complaints of recurrent left knee pain and instability.  He reported occasional swelling, denied locking, and noted a feeling of giving way but no gross instability.  His PE showed a trace effusion and ROM measurements of flexion to 130 degrees (normal 140) and extension of -3 degrees (normal 0).  There was no kneecap grinding, apprehension, or significant joint line tenderness.  The CI had a 2A Lachman test (5-10 millimeters of anterior translation of the knee joint with a firm end-point) with no comparison provided to the unaffected knee.  Anterior and posterior drawer tests were negative.  There were no gait abnormalities reported. 

At the 15 May 2007 VA Compensation and Pension (C&P) examination, 2 months after separation, the CI reported continued left knee pain.  He also reported weakness and instability and stated that the left knee will give out on him on rare occasions once every 3 months.  His PE revealed a normal gait with the ability to walk on his heels or toes, thus indicating adequate motor strength of the lower extremity.  Reflexes were normal and strength was noted as “4/5 with slight giving way”.  ROM measurements indicated flexion to 120 degrees and normal extension of 0 degrees.  There was increased pain with repetitive motion.

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), citing “rated for knee instability.”  The VA rated the left knee condition 10%, coded 5010 (arthritis, due to trauma, substantiated by X-ray findings), citing permanently worsened as a result of service.  Panel members agreed that in the absence of a boney malunion, pre-separation examinations did support a degree of joint instability no greater than that of a “moderate” (20%) disabling condition.  Additionally, there was no limitation of flexion or extension that supported a rating under the VASRD diagnostic codes for limitation of motion (5260 or 5261).   Therefore, 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 chronic left knee pain condition.
 
Contended PEB Condition:  Chronic Left Ankle Pain.  The panel’s main charge is to assess the fairness of the PEB’s determination that the contended condition was not unfitting.  Although the contended condition was profiled, it was not implicated in the commander’s statement nor judged to fail retention standards.  A clinical encounter dated 21 July 2006, 7 months prior to separation, noted “…no ankle pain, swelling, or stiffness” under historical “Review of Systems”.  Additionally, there was no recorded documentation of any further injury or adverse pathology directed towards the left ankle during the interim 7 month period until the CI’s separation date.    All panel members agreed that there was no performance-based evidence that the ankle condition significantly interfered with satisfactory duty performance at or near separation.  The VA C&P examination 2 months after separation reported a non-compensable evaluation citing full ROM and no pain during repetitive movement.  After due deliberation, the panel concluded there was insufficient cause to recommend a change in the PEB’s fitness determination for the contended left ankle condition, so no additional disability rating is recommended.  

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.  In the matter of the contended chronic left ankle condition, the panel recommends no change from the PEB’s determination 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 20170401, w/attachments
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Record 

AR20180006239, 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