RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2017-05077
BRANCH OF SERVICE:  ARMY 	SEPARATION DATE:  20070521

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E5, Motor Transport Operator, medically separated for “chronic pain left leg” with a  disability rating of 10%.  

CI CONTENTION:  “Sleeping/nightmare problems getting worse.”  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 - 20070413	VARD - 20080111	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Pain Left Leg 	5099-5003	10%	Status Post Left ACL Repair	5260-5014	10%	20071001	
			Scars, Left Knee	7805	0%	20071001	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  50% 	

ANALYSIS SUMMARY:  

Chronic Pain Left [Knee].  According to the service treatment record (STR) and MEB narrative summary (NARSUM), the CI underwent anterior cruciate ligament (ACL) and posterior compartment reconstruction on 24 August 2006.  She developed arthrofibrosis (adhesions) that required arthroscopic lysis and manipulation on 27 November 2006, 5 months before separation, but suffered no more complications.  Her range of motion (ROM) improved significantly, but she did not recover sufficiently to return to full duty.  

There were numerous post-operative STR clinical entries that documented improving ROM, with later entries recording flexion in the 100-120 degree range (normal 140) and 0 degrees extension (normal).  There was documentation of intermittent effusion, but the CI had a normal gait and no meniscal impingement (locking).  There was no STR evidence contrary to any of these findings.  

The 22 March 2007 MEB NARSUM, 2 months prior to separation, documented persistent pain rated “slight and constant” that prevented physical training and general soldiering requirements.  The physical examination recorded ambulation without assistive devices, “mild” tenderness, no effusion and normal strength without noting signs of meniscal impingement.  Goniometric ROM measurements were flexion of 125 degrees and extension of 0 degrees.

At the 1 October 2007 VA Compensation and Pension (C&P) evaluation, 4 months after separation, the CI reported constant pain rated 9/10 that rendered her unable “to run, jog, jump, walk up stairs properly or walk long distances.”  The physical examination recorded a normal gait with no effusion, tenderness or meniscal impingement.  Measured ROM was flexion to 90 degrees with 0 degrees extension, specifying no degradation with repetition.

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the left knee condition 10%, coded 5099-5003 (analogous to degenerative arthritis), citing the US Army Physical Disability Agency pain policy.  The VA also rated the condition 10%, coded 5260-5014 (limitation of flexion - osteomalacia), citing painful motion.  The VA additionally conferred a 0% rating for the surgical scars, for which there was no functional link to fitness to justify service rating.  There was no evidence for compensable ROM limitation (codes 5260 or 5261), persistent effusion and locking (code 5258), or fracture with nonunion or malunion (code 5262) to support a rating higher than 10%.  There were no other applicable coding or rating options.  After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the panel concluded that there was insufficient cause to recommend a change in the PEB adjudication of the left knee condition.

BOARD FINDINGS:  In the matter of the left 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 20170603, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Record 

AR20180007362, 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