RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2017-04626
BRANCH OF SERVICE:  ARMY	SEPARATION DATE:  20081115

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E4, Cannon Crewmember, medically separated for “right knee pain” with a disability rating of 10%.  

CI CONTENTION:  Reevaluated all conditions.  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 - 20080812	VARD - 20090904	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Right Knee Pain 	5099-5003	10%	Right Knee ACL and MCL Repair with DJD	5010	10%	20090430	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  30%	

ANALYSIS SUMMARY:  

Right Knee Pain:  According to the service treatment record and MEB narrative summary (NARSUM), the CI’s right knee condition began in Nov 2007 after a jumping injury.  An MRI showed a torn anterior cruciate ligament (ACL) and medial collateral ligament (MCL).  He re-injured the knee in December 2007, when he jumped out of a truck while wearing full combat gear.  He underwent surgical reconstruction of both ligaments in April 2008. 

During the orthopedic clinic visit on 2 May 2008, 1 month post-surgery and 6 months pre-separation, the CI reported minimal pain with difficulty regaining flexion.  His physical examination (PE) revealed tenderness about the right knee.  Right knee range of motion (ROM) was painful and decreased in flexion to 45 degrees (normal 140), but extension was full.  Muscle weakness and effusion of the right knee was present, but there was no numbness, swelling, or instability noted.  

The 2 July 2008 MEB NARSUM examination, 5 months prior to separation, noted complaints of knee stiffness and a sense of instability.  Knee pain worsened with prolonged standing.  Limited motion of the right knee made it hard to run or get up and down from a chair.  His PE revealed a small to moderate effusion, but no instability and normal tracking of the kneecap.  Meniscal and instability tests were negative.  

At the orthopedic clinic visit on 18 July 2008, 3 months post-surgery and 4 months pre-separation, the CI was feeling no pain while wearing a brace.  The PE showed no knee swelling or instability.  The examiner noted abnormal knee motion with limited flexion to 135 degrees.  

At the 30 April 2009 VA Compensation and Pension (C&P) evaluation, 5 months after separation, the CI reported his right knee was stable but painful and swelled with increased activity.  His PE revealed two healed lateral surgical scars which were depressed and red, but non-tender and non-ulcerated.  The CI had painful ROM with crepitus (grinding) at 110 degrees of flexion and full extension.  There was no change to ROM after repetition.  X-rays of the right knee noted degenerative joint disease (DJD). 

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the right knee condition at 10%, analogously coded 5099-5003 (arthritis, degenerative), citing flexion limited by pain.  The VA also rated the right knee condition at 10%, coded 5010, (arthritis, due to trauma, substantiated by X-ray findings), based on the C&P examination 5 months after separation, citing painful or limited motion of a major joint or group of minor joints.  Within the last 6 months prior to separation, the orthopedic evaluation noting 45 degrees of flexion supported a 10% rating under the diagnostic code for limitation of flexion (5260).  There was no limitation of motion which supported a rating under the diagnostic code for limitation of extension (5261).  Painful motion with functional loss was present in the post-separation examination, but its rating consideration would be of no additional benefit to the CI versus rating under 5260.  Additionally, there was no history or evidence of dislocated meniscus or loose body causing frequent locking with recurrent effusions (5258), or history of surgery to remove a meniscus (5259) to support a rating under those codes.  There was 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).  There was therefore no VASRD §4.71a rating higher than the 10% adjudicated by the PEB under any applicable code.  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 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 20170528, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record 

AR20180006704, 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