[AR Number], XXXXXXXXXX. 

XXXXXXXXXX
XXXXXXXXXX
XXXXXXXXXX

Dear XXXXXXXXXX:

	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.

Enclosure

RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXX.  	CASE:  PD-2017-04776
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20080824

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects this covered individual (CI) was a Reserve W2, Student, medically separated for “chronic left knee pain” with a disability rating of 10%.   

CI CONTENTION:  Review 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 - 20080507	VARD - 20081211	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Left Knee Pain	5099-5003	10%	Left Knee Strain	5257	10%	20080707	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  40%	

ANALYSIS SUMMARY:  

Chronic Left Knee Pain.  According to the service treatment record and MEB narrative summary (NARSUM), the CI underwent semi-emergent surgery in November 2006 to excise a torn meniscus, and a procedure in January 2007 to repair an anterior cruciate ligament (ACL) tear. 

During the 25 February 2008 MEB examination (recorded on DD Forms 2807-1 and 2808), 6 months prior to separation, the CI reported regular left knee swelling with a history of meniscectomy.  Physical examination showed crepitus and full range of motion (ROM) with “deep” pain at full flexion.  At the MEB NARSUM examination the next day, the CI complained of constant left knee pain, rated at 9/10, due to exacerbations from weight-bearing exercise.  He also complained of laxity with walking and said, “it feels as if it hyper-extends and then gives out…a couple times per week.”  The examiner referred to the MEB examination findings.  

At the 28 March 2008 MEB goniometric ROM evaluation by physical therapy, the CI reported that left knee pain caused limping and was aggravated by prolonged walking.  The knee also gave out 2-3 times a day and felt unstable.  On examination, the CI had a normal gait and a 2+ Lachman’s test.  Knee ROM was 0-130 degrees (normal 0-140), with pain increasing at 125 degrees, and no change after repetition.  

During the 7 July 2008 VA Compensation and Pension (C&P) examination, 6 weeks before separation, the CI reported constant, dull, achy pain with occasional swelling and persistent stiffness and buckling.  Stepping on uneven surfaces, prolonged standing or walking caused the buckling, but a knee brace helped somewhat.  Physical examination showed a normal gait with trace left knee warmth.  Knee ROM testing showed limitation of flexion at 120 degrees, due to pain, and normal extension.  There was no additional limitation of motion after repetition.

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the left knee condition 10%, analogously coded 5099-5003 (degenerative arthritis), citing periarticular pathology with limitation of motion.  The VA also rated the left knee condition 10%, but coded 5257 (knee impairment due to recurrent subluxation or lateral instability), based on the C&P examination, citing slight recurrent subluxation or lateral instability.  Members agreed 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 for coding under 5258, and while code 5259 (cartilage, semilunar, removal of, symptomatic) was applicable, the maximum 10% rating provided no benefit to the CI.  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 chronic 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: