RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXX	CASE:  PD-2017-05271
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20060705

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E4, Military Police, medically separated for “right knee instability” with a disability rating of 20%.    

CI CONTENTION:  Review of all conditions requested.  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 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 - 20060525	VARD - 20061218	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Right Knee Instability	5257	20%	Residuals, Right Knee Surgery	5257	10%	20061019	
			Limitation of Motion of Right Knee	5260	10%	20061019	
COMBINED RATING:  20%	COMBINED RATING OF ALL VA CONDITIONS:  20%	

ANALYSIS SUMMARY:  

Right Knee Instability.  According to the service treatment record and MEB narrative summary (NARSUM), the CI had a history of right knee surgery for anterior and posterior cruciate ligament reconstruction and posterolateral corner reconstruction in October 2004 and he underwent additional right knee surgery in 26 July 2005 for revision anterior and posterior cruciate ligament reconstructions using allografts.  Chondromalacia of the medial femoral condyle and tibial plateau was noted during the surgery as well.  Following surgery the CI reported improvement in leg strength and range of motion (ROM), but had persistent pain, an inability to run, and recurrent instability with walking on irregular terrain, and when changing directions abruptly.  

The 29 March 2006 MEB NARSUM examination, 3 months prior to separation, noted complaints of recurrent right knee instability and pain.  Physical examination showed knee ROM of 0 to 130 degrees extension to flexion (normal 0-140).  There was evidence of posterior and medial instability.  There was no evidence of meniscal pathology.  There was diffuse medial tenderness.  Knee X-rays showed post-operative changes and mild degenerative joint disease.  
At the 19 October 2006 VA Compensation and Pension (C&P) examination, 3 months after separation, the CI reported pain with weakness, stiffness, swelling, warmth, redness, instability, and lack of endurance.  He was able to function with the pain.  He did not use any assistive device for ambulation but he did use a brace with prolonged activity.  The CI reported there was no effect on his function as a student or his activities of daily living.  Physical examination showed a normal posture and gait.  There was evidence of residual instability or meniscal pathology and no weakness or tenderness was noted.  .  Knee ROM was 0 to 120 degrees “limited by body habitus.”  There was pain at end range of extension.  There was no additional limitation of motion with repetition.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the right knee condition 20%, coded 5257 (other impairment of knee).  Using the same code, the VA rated the right knee condition 10% based on the C&P examination, citing recurrent subluxation or lateral instability of the knee which was slight.  The VA also provided an additional rating for the right knee condition; 10%, coded 5260 (limitation of flexion of leg), based on the C&P examination, citing limited or painful motion of a major joint. 

The MEB forwarded two knee diagnoses: right knee instability and pain, and right knee osteoarthritis.  The PEB combined them and rated 20% as a single unfitting condition, coded 5257.  The CI requested review of all conditions and therefore the panel agreed dual rating of the knee for instability and limitation of motion (as sanctioned by the VA) was in the panel’s scope of review.  A 10% rating was supported for slight knee impairment due to instability coded 5257 based on the VA examination which showed a normal gait without use of an assistive device and use of a knee brace for prolonged activity.  The panel agreed the evidence did not support characterizing the CI’s disability due to residual instability as moderate for a higher rating based on the presence of a normal gait and no effect on activities of daily living noted at the VA examination.  

The panel next considered if dual rating of the knee was warranted in this case.  Following the last surgery, the CI reported significant knee pain with standing and prolonged walking.  Knee arthritis was noted at the time of surgery and on X-rays.  The panel agreed dual rating of the knee condition was warranted and a 10% rating was supported for painful motion with functional loss (based on §§4.59, 4.40 and 4.45) coded 5099-5003 (degenerative arthritis).  The 5259 code (cartilage, semilunar, removal of, symptomatic) was applicable in this case but the maximum 10% rating under that code provided no benefit to the CI.  There was no limitation of motion which supported a higher rating under the diagnostic codes for limitation of flexion or extension (5260, 5261).  There was no history or evidence of dislocated meniscus or loose body causing frequent locking with recurrent effusions (5258) to support a higher rating under this code.  The panel’s dual rating recommendation for the right knee of 10% (5257) plus 10% (5099-5003) results in the same final combined 20% rating as that of the PEB and provides no ratings benefit to the CI.  Therefore, no change to the PEB’ adjudication is recommended.  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 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.  

PD-2017-05271

ARXXXXXXXXXXX, XXXXXXXXXXXXXXXXXXXX

Dear XXXXXXXXXXXXXXX

	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

PD-2017-05271