RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXXX	CASE:  PD-2017-04635
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20090426

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E3, Helicopter Repairman, medically separated for “chronic left knee pain” with a disability rating of 10%.  

CI CONTENTION:  “My surgically repaired left knee has been locking up multiple times a week at night.”  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 - 20090112	VARD - 20091022	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Left Knee Pain…	5009-5003	10%	Residuals of Left Knee ACL Surgical Repair	5260	10%	20090917	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  60%	

ANALYSIS SUMMARY:  

Left Knee Pain.  According to the service treatment record and MEB narrative summary (NARSUM), the CI underwent left knee surgery in January 2008 for medial and lateral meniscal tears, anterior cruciate ligament (ACL) deficiency, and a lateral femoral condyle chondral lesion.  A second left knee ACL surgery was required in March 2008.  At a physical therapy (PT) appointment on 1 July 2008, 9 months prior to separation, the CI reported chronic left knee pain rated at 3/10.  On examination, he walked with a normal gait and had normal quadriceps tone.  Left knee range of motion (ROM) showed flexion of 125 degrees (normal 140) and extension of 0 degrees (normal).  At the PT visit on 22 August 2008, 8 months before separation, the CI reported chronic left knee pain rate at 3/10, and the provider noted a normal gait, no swelling, and 5/5 strength from hip to knee.  The knee was stable to anterior drawer, Lachman’s and pivot shift testing, with flexion of 135 degrees and extension of 0 degrees.  

During the 18 September 2008 MEB examination (recorded on DD Forms 2807-1 and 2808), 7 months before separation, the CI reported chronic left knee pain.  Physical examination revealed a normal gait, no gross edema, discoloration or tenderness, and a stable anterior drawer sign.  Lachman’s and valgus/varus stress tests were negative and motion was limited due to pain only.  

At the 17 September 2009 VA Compensation and Pension (C&P) examination, 5 months after separation, the CI reported left knee pain and stiffness.  Physical examination showed a normal gait, tenderness and crepitus; neurological findings were normal.  Left knee flexion was to 110 degrees and extension to 0 degrees with painful motion.  Knee X-rays the same day revealed post-operative changes from the ACL repair, but joint spaces were maintained with no joint effusion or acute bone abnormality.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the left knee condition 10%, analogously coded 5003 (arthritis, degenerative), citing evidence of painful motion of one major joint.  The VA also rated the left knee condition 10%, coded 5260 (leg, limitation of flexion of), based on the C&P examination, citing painful motion of an injured joint.  Members noted there was no limitation of flexion or extension which supported a rating under diagnostic codes 5260 or 5261.  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) to support a rating under that code, and 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 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 left knee condition.  

BOARD FINDINGS:  In the matter of the left knee pain 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:  

 [AR NUMBER], XXXXXXXXXXXXXXXXXXXX

XXXXXXXXXXXXXXXXXXXX
XXXXXXXXXXXXXXXXXXXX
XXXXXXXXXXXXXXXXXXXX

Dear XXXXXXXXXXXXXXXXXXXX:

	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.