[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.
Sincerely,					      
Enclosure

RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME: XXXXXXXXXX.  	CASE:  PD-2017-04847
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20061207

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E5, Bradley Systems Maintainer, medically separated for “right knee pain” with a disability rating of 10%.    

CI CONTENTION:  No specific contention was made.  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 – 20060831	VARD - 20070511	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Right Knee Pain	5257	10%	Post-Surgical Repair for Right Knee ACL Tear Per MRI	5010-5260	10%	20070331	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  40%	

ANALYSIS SUMMARY:  

Right Knee Pain.  According to the service treatment record and MEB narrative summary (NARSUM), the CI’s right knee pain began in April 2002 after he fell during a road march while deployed.  In December 2002, an MRI revealed a partial tear of the anterior cruciate ligament (ACL), and arthroscopic surgery with ACL shrinkage was performed without complication.  Later, the CI deployed to Iraq and sustained another right knee injury that resulted in a complete ACL tear.  Reconstructive surgery was performed, during which time cartilage damage was noted.  Post-operatively, the CI continued to have pain, swelling, and mild instability of the right knee.

During the 7 June 2006 MEB examination (recorded on DD Forms 2807-1 and 2808), 6 months prior to separation, the CI reported arthritis with right knee pain and swelling, and that wearing a knee brace helped with pain and stability.  The 24 July 2006 MEB NARSUM examination, 4 months before separation, noted complaints of recurrent chronic knee pain that limited ambulatory and athletic activities.  The CI wore a brace that replicated ACL motion and provided more stability.  Physical examination showed full knee range of motion (ROM) with mild medial collateral laxity, and a minimally positive Lachman’s test.  He had an antalgic gait, no obvious leg or thigh atrophy, and normal neurological examination findings.

At the 31 March 2007 VA Compensation and Pension (C&P) examination, 4 months after separation, the CI reported some anterior right knee pain but significantly improved stability.  He continued to wear the ACL brace which was helpful.  Physical examination showed some tenderness over the proximal patella tendon, but no pain over the medial and lateral joint line.  All knee stability tests were negative, sensory function of the right leg was intact, and muscle strength was normal.  ROM tests showed “full flexion and extension, from 0-130 degrees.”

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the right knee condition 10%, coded 5257 (knee, other impairment of: recurrent subluxation or lateral instability), citing mild medial collateral laxity and minimally positive Lachman testing.  The VA also rated the right knee condition 10%, but analogously coded 5010-5260 (arthritis due to trauma-leg, limitation of flexion of), based on the C&P examination, citing painful motion of a major joint.  Members noted there was no limitation of motion which supported a higher rating under the diagnostic codes for limitation of flexion or extension (5260, 5261), and no history of dislocated meniscus or loose body causing frequent locking with recurrent effusions (5258) to support a higher rating under that code.  Although there was recurrent collateral laxity, the NARSUM indicated it was minimal, and that testing for instability was also minimally positive.  Additionally, at the time of the C&P examination, all tests for instability were negative.  The panel therefore agreed that a higher 20% rating under code 5257 was not warranted, and there was no higher rating 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 right knee condition.  

BOARD FINDINGS:  In the matter of the right 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.