RECORD OF PROCEEDINGS PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXX		CASE: PD-2017-04416 BRANCH OF SERVICE: ARMY	SEPARATION DATE: 20071105

SUMMARY OF CASE: Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E4, Infantryman, medically separated for “right ACL [anterior cruciate ligament] tear” with a disability rating of 20%.

CI CONTENTION: Review requested of right knee (tore ACL and meniscus twice) as well as additional conditions not identified by the Medical Evaluation Board (MEB) and Physical Evaluation Board (PEB) was also requested.  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 - 20071001	VARD - 20080306	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Right ACL Tear…	5257	20%	Status Post Right Knee Injury, ACL Tear	5257	10%	20071217	
Lower Back Pain	Not Unfitting	Thoracic Spine Strain	5237	0%	20071217	
Astigmatism	Not Unfitting	No VA Placement	
Myopia	Not Unfitting		
COMBINED RATING: 20%	COMBINED RATING OF ALL VA CONDITIONS: 10%	

ANALYSIS SUMMARY:

Right ACL Tear. According to the service treatment record and MEB narrative summary (NARSUM), the CI underwent right knee surgery in December 2001 for a torn ACL. In 2004, he enlisted in the Army and the right knee was cleared by an orthopedist. In May 2006, during a 12- mile ruck march, he twisted his knee and tore his right ACL again, and subsequently had an ACL repair with lateral meniscectomy in August 2006. In January 2007, while walking down a mountain, he slipped on rocks and twisted his right knee, and an MRI on 20 June 2007 revealed

findings consistent with the prior ACL graft being torn or partially torn (clinical correlation recommended), an extensive tear or post-operative changes to the right lateral meniscus, bone bruising, effusion, and degenerative changes.

At an orthopedic visit on 13 July 2007, 4 months prior to separation, the CI reported right knee instability. Physical examination showed lateral joint line tenderness and a positive anterior drawer sign, but no swelling, redness or crepitus. McMurray’s (for meniscal signs), patella femoral grind, and apprehension tests were all negative. Arthrometer (KT 2000) results for ACL laxity showed the right knee at 10mm, with the left knee at 3mm (7mm translation difference). Right knee range of motion (ROM) was “full,” but not quantified, and an MRI clinical interpretation indicated a complete ACL tear, lateral meniscus tear, and knee effusion.

At the 10 August 2007 MEB physical therapy ROM evaluation, 3 months before separation, the CI reported severe right knee pain rated at 7-8/10. Right knee ROM, after repetition, showed flexion to 120 degrees (normal 140) with hyperextension to 5 degrees (normal 0), with painful motion. No knee laxity examination was recorded. The 18 September2007 MEB NARSUM examination, 2 months prior to separation, noted complaints of constant right knee pain, rated at 5/10, and exacerbated by activity. Physical examination revealed tenderness and mild crepitus, but no instability was appreciated, and the above orthopedic KT2000 measurements were referenced.

At the 17 December 2007 VA Compensation and Pension (C&P) examination, 1 month after separation, the CI reported constant burning, aching and sharp right knee pain, rated at 7/10, with weakness while running and walking, and stiffness after working out for a long time. Physical examination showed a normal gait and no signs of fluid, swelling, weakness, tenderness, redness, heat, subluxation, guarding of movement, locking pain or crepitus. Anterior and posterior cruciate ligament stability tests showed slight instability, but medial and lateral collateral ligament tests were within normal limits. Medial and lateral meniscus tests were also normal. Right knee ROM showed flexion of 140 degrees and extension of 0 degrees, with painful motion.

The panel directed attention to its rating recommendation based on the above evidence. The PEB rated the right knee condition 20%, coded 5257 (knee, other impairment of), citing “7mm translation difference on KT200,” the inability to perform military specialty duties (or run and ruck), and DODI 1332.39 paragraph E2.A1.1.15.2.2. (“…20 percent for moderate instability”). The VA rated the right knee condition 10%, coded 5257, based on the C&P examination, citing slight, recurrent subluxation or lateral instability of the knee.

Given the PEB’s coding and the CI’s contention, panel members adjudged that dual rating was in scope and applicable in this case. The panel also deliberated whether additional rating for painful motion (IAW §4.59) and/or residuals of meniscal surgery was also applicable, noting that rating under code 5259 (cartilage, semilunar, symptomatic removal of) includes painful motion, while code 5257 does not. There was no evidence of marked knee disability to support a 30% rating under code 5255/5262 code (femur, impairment of/tibia and fibula, impairment of); no compensable limitation of motion (5260, 5261); and no history or evidence of dislocated meniscus or loose body causing frequent locking with recurrent effusions (5258) to support ratings under these respective codes. Because the CI had a prior partial meniscal resection and meniscal re-tear, and the PT and VA examinations documented painful motion (§4.59), panel members agreed the right knee disability supported a 10% rating analogous to code 5259. The panel considered that the NARSUM noted no instability and the VA examination noted only slight instability (10%), and both examinations were closer to separation than the orthopedic examination finding of greater instability (20%). Therefore, if a dual rating was applied using evidence from the examinations most proximate to separation for a meniscal (5299-5259   with
§4.59) rating of 10%, the 5257 rating from the same examinations would only be 10% as well. This  change would yield a combined rating of 20% and offer no benefit to the  CI.        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: Lower Back Pain, Astigmatism, and Myopia. The panel’s main charge is to assess the fairness of the PEB determination that the contended conditions were not unfitting. None 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 lower back pain, astigmatism and myopia conditions, 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:

PD-2017-04416 

AR20190012260, XXXXXXXXXXXXXXXXXXXXXX 

Dear XXXXXXXXXXXXXXXX

	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.

PD-2017-04416