RECORD OF PROCEEDINGS PHYSICAL DISABILITY BOARD OF REVIEW
NAME: XXXXXXXXXXXXXXXXXXX	CASE: PD-2017-05447
BRANCH OF SERVICE: ARMY	SEPARATION DATE: 20080320

SUMMARY OF CASE: Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E5, Power Generator Equipment Repairer, medically separated for “residual ACL instability with a 1+ Lachman of the left knee” 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 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:

USAPDA ADMIN CORR – 20080503	VARD - NA	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Left Knee Residuals ACL Instability	5257	10%	No VA Examination Proximate to Separation in Evidence	
COMBINED RATING: 10%	COMBINED RATING OF ALL VA CONDITIONS: NA	

ANALYSIS SUMMARY:

Left Knee Residual Anterior Cruciate Ligament (ACL) Instability. According to the service treatment record and MEB narrative summary (NARSUM), the CI underwent multiple left knee surgeries, the first of which was an ACL reconstruction with a hamstring autograft in 2000. On 3 February 2006 he had a left knee ACL revision reconstruction with allograft as well as microfracture of the femoral trochlea and a lateral meniscal tear debridement. The CI then went thru extensive physical therapy and bracing, but pain continued. He then underwent several subsequent procedures including a left knee anterior tibial osteotomy and left trochlear autologous chondrocyte implantation (Carticel) in July 2006 as well as knee arthroscopies for debridement of a fat pad in September 2006 and debridement of the left trochlea overgrowth of the Carticel implantation site in January 2007. At an orthopedic clinic visit in March 2007 and subsequent visits through September 2007, the CI stated his knee was stable with less pain and catching, but he continued to describe pain at approximately 30 degrees of knee flexion, which limited his ability to climb stairs. Examination revealed no swelling, induration, edema, erythema,a or warmth of the knee. Left knee motion was normal with pain at 30 degrees of flexion. There was good patellar excursion and no instability (Lachman 1a and negative anterior/posterior drawer tests) or laxity (negative varus/valgus testing).

During the 6 August 2007 MEB examination (recorded on DD Forms 2807-1 and 2808), 8 months prior to separation, the CI reported left knee swelling, giving out, and pain. Physical examination revealed full range of motion (ROM), no effusion and no tenderness of the left knee. The 4 September 2007 MEB NARSUM examination noted the complaint of left knee pain. Physical examination of the left knee showed well healed incisions and no effusion. ROM for flexion was 130 degrees (normal 140) and there was full extension (normal 0). He had a 1A Lachman test and negative anterior drawer and posterior drawer tests. Varus and valgus testing (to determine laxity) was negative.

At a private orthopedic clinic visit in November 2007, examination revealed active ROM of the left knee was 8 degrees to 110 degrees. The ACL demonstrated a 1+ anterior drawer, 1+ Lachman’s test, 1+ Slocum’s, and 2+ Larson’s tests. The posterior cruciate ligament demonstrated good stability as did the medial and collateral ligaments. There was no evidence of laxity or instability. Meniscal testing was consistent with a degenerative pattern of the joint positive in the medial compartment. There was no evidence of a meniscal tear. There was pain to compression and some crepitation palpable of the patellofemoral joint. Patella tracking appeared satisfactory. The CI could not perform a single leg squat because of pain. With stairs he was unable to leadoff with his left leg going up or to trail coming down. The gait pattern was abnormal with external rotation when he ambulated. The strength of the hamstrings was 4/5 and the quadriceps was 4+/5. X-rays of the left knee demonstrated osteophytes in the intercondylar femoral notch area and flattening of the medial femoral condyle and the tibial condyles consistent with an arthritic process. The chondral (cartilage) interval was narrowed in the medial compartment and to some degree in the lateral compartment. There were osteophytes of the patellofemoral joint and a lateral overhang of the patella, which was bipartite. The examiner’s assessment was left knee mild ACL insufficiency, traumatic degenerative joint disease, and chronic patellofemoral arthritis/bipartite patella. There was no VA examination proximate to separation in evidence.

The panel directed attention to its rating recommendation based on the above evidence. The PEB reconsideration and USAPDA administrative correction rated the left knee residual ACL instability 10%, coded 5257 (knee, other impairment), citing pain and instability with full ROM. The PEB noted the CI had pain and instability, but only rated for instability. The VA permits rating for both pain and instability. While there was slight knee impairment, there was no evidence of moderate or severe subluxation or lateral instability to warrant a rating higher than 10% using code 5257. However, there was evidence of painful motion with functional loss supporting a 10% rating (based on §§4.59, 4.40 and 4.45). The persistence of pain after meniscal surgery likewise warrants a 10% rating under the 5259 code (cartilage, semilunar, removal of symptomatic). Therefore, panel members determined a 10% rating for the instability, coded 5257 and a 10% rating for painful motion, coded 5099-5003 is applicable and appropriate. 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 residual ACL instability condition, coded 5257 and a disability rating of 10% for left knee pain, coded 5099-5003.

BOARD FINDINGS: In the matter of the left knee residual anterior cruciate ligament instability, the panel recommends a disability rating of 10%, coded 5257 IAW VASRD §4.71a and a disability rating of 10%, coded 5099-5003 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 Anterior Cruciate Ligament Instability	5257	10%	
Left Knee Anterior Cruciate Ligament Instability/Pain	5099-5003	10%	
	COMBINED	20%	

AR20200004190

DEPARTMENT OF THE ARMY
ARMY REVIEW BOARDS AGENCY 251 18TH STREET SOUTH, SUITE 385
ARLINGTON, VA 22202-3531

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.

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