RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXX	CASE:  PD-2017-05237
BRANCH OF SERVICE:  Army	SEPARATION DATE:  20070323

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects this covered individual (CI) was a  National Guard E4, Health Care Specialist, medically separated for “left knee pain” with a disability rating of 10%.  

CI CONTENTION:  “My health issues have always caused pain.”  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 - 20070302	VARD - 20080917	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Left Knee Pain	5257	10%	Left PCL Rupture with Instability	5257	10%	20080905	
			Left Medial Meniscal Derangement 	5260	10%	20080905	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  20%	

ANALYSIS SUMMARY:  

Left Knee Pain.  According to the service treatment record and MEB narrative summary (NARSUM), the CI’s left knee condition began in February 2002 after playing basketball and reinjured it in 2004.  An MRI done in 2005 showed a posterior cruciate ligament (PCL) tear as well as a medial meniscus tear, but the CI declined surgical correction.  At the 16 June 2006 orthopedic clinic appointment, 9 months prior to separation, the CI reported continued left knee pain and instability, which occurred while walking, and felt as though his tibia was “going backwards.”  Physical examination showed mild tenderness with no swelling or effusion.  He had full left knee range of motion (ROM) with flexion of 140 degrees (normal) and hyperextension of 5 degrees (normal 0).  Although his left knee was laterally stable, he had a 1 to 2+ posterior drawer (showing PCL laxity).  The patella grind test was mild and he had mild joint line tenderness.  He also demonstrated mild pain with McMurray’s (meniscal) testing.  On 14 July 2006 CI was fitted with a left knee brace.  At the 15 August 2006 orthopedic clinic appointment, 7 months prior to separation, the left knee examination documented full ROM with painful motion and instability.  The physical therapy (PT) MEB ROM study on 17 October 2006, 5 months prior to separation, showed flexion of 130 degrees and hyperextension of 5 degrees.  

During the 21 February 2007 MEB NARSUM examination, 1 month prior to separation, the CI continued to have complaints of left knee instability and pain with running, jumping or climbing.  Physical examination showed a positive quad active test (left).  His left knee ROM was 0-130 degrees (normal 0-140) with pain at the extreme of motion.  There was a 1+ posterior drawer test.  He had medial joint line tenderness (meniscal sign).  Motor strength was normal without left lower extremity neurovascular deficits.  X-rays and MRI confirmed the PCL injury as well as posterior horn of the medial meniscus tear that did not appear to be displaced.  The MEB diagnosis was “left knee pain and instability due to posterior cruciate ligament injury as well as meniscus injury.”  

The 5 September VA Compensation and Pension (C&P) examination, 17 months after separation, noted complaints of left knee pain with intermittent locking, instability and swelling.  The left knee examination revealed ROM of 0-120 degrees with painful motion.  Anteriorly-to-posteriorly, there was a 6mm posterior deflection with subluxation of the tibia.  There was tenderness at the medial joint space with grade 2 moderate crepitus and abnormal McMurray testing for meniscal derangement medially.  The diagnoses were left meniscal derangement and left PCL rupture with instability, as well as left chondromalacia and inferior tendonitis of the patella.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the left knee condition 10%, coded 5257 (knee, other impairment of), citing 1+ posterior drawer and medial joint line tenderness.  The VA rated the left knee condition 10%, coded 5257; and 10%, coded 5260 (limitation of leg flexion), citing painful motion and slight instability.  There was no evidence of moderate or severe subluxation or lateral instability to support a higher rating under the 5257 code.  There was no limitation of motion (5260, 5261), and no history of dislocated meniscus or loose body causing frequent locking with recurrent effusions (5258) to support a rating under that code.  There was likewise no fracture, nonunion or malunion of the femur or tibia to support consideration under the codes for knee impairment related to long bone conditions (5255, 5262).  However, it was noted that the PEB rated the knee condition at 10% for instability, while also referencing a degree of knee pain and abnormal meniscal findings that factored in the disability.  Panel members therefore concluded that consideration of dual knee rating for instability and painful motion was appropriate.  The panel considered the evidence of meniscal pathology without a history of surgery for an analogous rating under code 5259 for symptomatic semilunar cartilage.  Most of the examinations proximate to separation showed evidence of painful motion or meniscal signs with functional loss supporting a 10% rating (based on §4.59, §4.40 and §4.45).  After due deliberation, considering all the evidence and mindful of VASRD §4.3 (reasonable doubt), the panel recommends a disability rating of 10% for the left knee (PCL instability) condition, coded 5257, plus an additional rating of 10% for the left knee (meniscal and pain) condition, coded 5299-5260.  

BOARD FINDINGS:  In the matter of the left knee condition, the panel recommends a disability rating of 10%, coded 5257; and a rating of 10%, coded 5299-5260; both IAW VASRD §4.71a.  There are no other conditions within the panel’s scope of review for consideration.  

The panel recommends the CI’s prior determination be modified as follows, effective the date of medical separation:  

CONDITION	VASRD CODE	PERMANENT RATING	
Left Knee Pain (PCL Instability)	5257	10%	
Left Knee Pain (Meniscal and Painful Motion)	5299-5260	10%	
COMBINED	20%	

XXXXXXXXXXXXXXXX

Dear XXXXXXXXXXXXXX

The Department of Defense Physical Disability Board of Review (DoD PDBR) reviewed your application and found that your disability rating should be modified but not to the degree that would justify changing your separation for disability with severance pay to a permanent retirement with disability.  I have reviewed the Board’s recommendation and record of proceedings (copy enclosed) and I accept its recommendation.  This will not result in any change to your separation document or the amount of severance pay.  A copy of this decision will be filed with your Physical Evaluation Board records.  I regret that the facts of the case did not provide you with the outcome you may have desired.
  
	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. 

	A copy of this decision has also been provided to the Department of Veterans Affairs.