RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2017-04015
BRANCH OF SERVICE:  army	SEPARATION DATE:  20050509

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E5, Utility Equipment Repairer, medically separated for “chronic right knee pain” with a disability rating of 20%.

CI CONTENTION:  Condition continues to worsen.  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 - 20050121	VARD - 20050822	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Right Knee Pain	5257	20%	Right Knee, S/P Failed ACL Reconstructions 	5260	10%	20050620	
COMBINED RATING:  20%	COMBINED RATING OF ALL VA CONDITIONS:  20%	

ANALYSIS SUMMARY:  

Chronic Right Knee Pain.  According to the service treatment record and MEB narrative summary (NARSUM), the CI injured his right knee playing basketball.  An MRI found an anterior cruciate ligament (ACL) tear and the CI underwent surgical repair in July 2001.  He did well until December 2003 when he reinjured the knee.  An MRI on 10 March 2004, revealed a possible torn medial meniscus and lateral collateral ligament injury.  Surgery was recommended, but the CI declined further surgical treatment.

The 15 August 2004 MEB NARSUM examination, 9 months prior to separation, noted complaints of chronic-daily right knee pain aggravated with prolonged walking, standing and going up and down stairs.  Physical examination revealed a normal gait and station, no evidence of atrophy, normal strength and no effusion.  Range of motion (ROM) was flexion to 110 degrees (normal 140) and extension of 0 degrees (normal); painful motion was not addressed.  Knee stability testing was negative.  The patella tracked well within the patellofemoral groove.

At the 20 August 2004 physical therapy ROM study, extension was 0 degrees and flexion was 110 degrees with painful motion.  The 26 August 2004 MEB examination (recorded on DD Forms 2807-1 and 2808), 9 months prior to separation, revealed normal ROM with clicking during ROM (painful motion).  At the 29 September 2004 clinic appointment, 7 months before separation, the CI reported twisting his knee that morning.  There was mild effusion and full ROM.  The examiner noted positive stability testing.

At the 20 June 2005 VA Compensation and Pension (C&P) evaluation, 1 month after separation, the CI reported right knee pain and swelling occurring as often as twice a week.  He had a prosthetic implant since 2001 and there was painful motion of the implanted joint.  Symptoms were frequent and caused joint instability.  There was decreased ability to walk, stand and run but no time lost from work.  His condition did not cause incapacitation.  Physical examination showed a normal posture and gait.  Stability and meniscus testing was normal.  Bilateral ROM was extension to 0 degrees and flexion to 140 degrees.  There was no additionally loss of ROM due to pain, fatigue, weakness, lack of endurance or incoordination after repetitive use.  Right knee X-rays showed postsurgical changes of the ACL repair with no significant arthritic change, fracture or subluxation.

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the right knee condition 20%, coded 5257 (knee instability, moderate), citing positive stability testing.  The VA rated the right knee condition 10%, coded 5260, (leg, limitation of flexion), based on the C&P examination 1 month after separation, citing a failed ACL reconstruction with continued pain.

The panel determined that the 5257 code used by the PEB was the most appropriate description of the pathology, given the positive stability testing.  The panel then considered if the right knee condition was at the moderate or severe level of disability.  The panel determined that the CI had continued pain and disruption of the ACL but full ROM, had not lost days from work and denied incapacitations, which was consistent with a moderate impairment versus a severe impairment.  There was no limitation of flexion (5260), extension (5261) or ankylosis (5256) to achieve a higher rating.  There was no fracture, nonunion or mal union of the femur or tibia to support consideration under the respective codes for knee impairment related to long bone conditions (5255, 5262).  The panel agreed the right knee condition supports a 20% rating as adjudicated by the PEB.  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 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 20170403, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record 

AR20180006250, 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