RECORD OF PROCEEDINGS PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX		CASE: PD-2017-03968 BRANCH OF SERVICE: ARMY	SEPARATION DATE: 20050910

SUMMARY OF CASE: Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E3, Signal Support System Specialist, medically separated for “posttraumatic arthritis left knee following ACL [anterior cruciate ligament] reconstruction” with a disability rating of 0%.

CI CONTENTION: Review requested of “constant left knee pain and swelling” as well as an additional condition (migraine headaches) 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 - 20050801	VARD - NA	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Posttraumatic Arthritis  Left Knee…	5010	0%	No VA Examination Proximate to Separation in Evidence	
COMBINED RATING: 0%	COMBINED RATING OF ALL VA CONDITIONS: NA	

ANALYSIS SUMMARY:

Left Knee Posttraumatic Arthritis. According to the service treatment record and MEB narrative summary (NARSUM), the CI underwent left knee surgery in December 2004 for a lateral meniscus repair and bone-tendon-bone ACL reconstruction. Despite physical therapy and medications, the left knee condition did not improve. During the 9 May 2005 MEB examination (recorded on DD Forms 2807-1 and 2808), 4 months prior to separation, the CI complained of left knee pain, swelling after physical activity, and giving out for which he wore a brace for support. Physical examination revealed range of motion (ROM) decreased about “50-60% due to pain.” In physical

therapy on 20 May 2005, he reported improvement since his last visit, and that he was able to jog with slight pain over the lateral knee. On examination, he had a slight limp and pain with squatting approximately 110 degrees.

The 14 July 2005 MEB NARSUM examination, 2 months prior to separation, noted complaints of anterior and lateral knee pain and difficulty with kneeling and ascending stairs. Physical examination showed no patellofemoral crepitus or pain with compression, although there was pain with patellar entrapment testing. Pivot shift and Lachman’s tests were negative, but there was joint line tenderness which was accentuated with McMurray’s maneuvering. Left knee X- rays revealed a small medial tibial spine spur and inferior hyperostosis of the patella. Measured ROM showed flexion of 118 degrees (normal 140) and extension of 0 degrees (normal) with no pain on motion.  There was no VA examination proximate to separation in evidence.

The panel directed attention to its rating recommendation based on the above evidence. The PEB rated the left knee condition 0%, coded 5010 (arthritis, due to trauma). Panel members agreed there was no limitation of flexion or extension (5260 or 5261) which supported compensable ratings, however, there was evidence of painful motion with functional loss supporting a 10% rating (based on §4.59, §4.40 and §4.45). 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). Code 5259 code (cartilage, semilunar, removal of, symptomatic) was also applicable in this case, and provided an alternate route to a 10% rating. After due deliberation, considering all the evidence and mindful of VASRD §4.3 (reasonable doubt), the panel recommends a disability rating of 10% for the left knee condition, coded 5259.

BOARD FINDINGS: In the matter of the left knee condition, the panel recommends a disability rating of 10%, coded 5259 IAW VASRD §4.71a. There are no other conditions within the panel’s scope of review for consideration.

The panel recommends the CI’s prior determination be modified as follows, effective the date of medical separation:

CONDITION	VASRD CODE	PERMANENT RATING	
Left Knee Posttraumatic Arthritis	5259	10%	

PD-2017-03968 

AR20190010932, XXXXXXXXXXXXXXXXXXXXXXX 

Dear XXXXXXXXXXXXXXXXXXX

The Department of Defense Physical Disability Board of Review (DoD PDBR) reviewed your application and found that your disability rating should be modified but not to the degree that would justify changing your separation for disability with severance pay to a permanent retirement with disability.  I have reviewed the Board’s recommendation and record of proceedings (copy enclosed) and I accept its recommendation.  This will not result in any change to your separation document or the amount of severance pay.  A copy of this decision will be filed with your Physical Evaluation Board records.  I regret that the facts of the case did not provide you with the outcome you may have desired.
  
	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. 

	A copy of this decision has also been provided to the Department of Veterans Affairs.

PD-2017-03968