RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2017-05527
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20060524

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E4, Petroleum Supply Specialist, medically separated for “chronic pain right knee” with a disability rating of 10%.  

CI CONTENTION:  “Both my left and right knees give out, lock up and make it hard to walk.”   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 – 20060407	VARD – 20070508	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Right Knee Pain 	5099-5003	10%	Status Post Right ACL Tear with Joint Instability	5257	10%	20070126	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  10%	

ANALYSIS SUMMARY:  

Right Knee Pain.  According to the service treatment record and MEB narrative summary (NARSUM), the CI underwent right knee arthroscopic surgery in September 2005 to repair a torn anterior cruciate ligament (ACL).  On 6 January 2006, an orthopedic range of motion (ROM) evaluation showed flexion to 120 degrees (normal 140) and extension to 5 degrees, but at the follow-up one month later, ROM was full.  At an orthopedic visit on 7 March 2006, the CI reported chronic pain and giving out even while wearing a brace.  There was no effusion, erythema, edema or tenderness, but there was positive quadriceps atrophy.  Provocative testing for ligamentous instability was negative, and active ROM was full.  

At the 27 March 2006 MEB PT ROM study, 2 months prior to separation, right knee flexion was to 120 degrees and extension to 0 degrees, with painful motion.  During the 30 March 2006 MEB examination (recorded on DD Forms 2807-1 and 2808), the examiner noted that the CI wore a knee brace and had decreased ROM (not quantified), with pain during extension.  The MEB NARSUM examination on the same day noted complaints of pain rated at 4/10, which increased to 9/10 with overexertion, and continued giving out or locking.  Physical examination showed right lower extremity strength of 4/5 due to pain.  Thigh girth at 8 cm proximal to the mid patellar line were: 40 cm on the right and 44 cm on the left; and at the mid patellar line were: 38.5 cm on both the right and left side. The examiner referred to the PT ROM measurements.  

At the 26 January 2007 VA Compensation and Pension (C&P) examination, 8 months after separation, the CI reported right knee giving way, instability, pain, stiffness and weakness, and wore a knee brace.  Physical examination showed a normal gait with sub-patellar tenderness.  Flexion was to 140 degrees, and extension to 0 degrees, with end range pain, but no additional loss of motion on repetitive use.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the right knee condition 10%, analogously coded 5099-5003 (arthritis, degenerative), citing application of the US Army Physical Disability Agency pain policy.  The VA also rated the right knee condition 10%, but coded 5257 (knee, recurrent subluxation or lateral instability), based on the C&P examination, citing slight instability.  Members agreed that there was no limitation of motion which supported a rating under the diagnostic codes for limitation of flexion or extension (5260, 5261).  However, there was evidence of painful motion with functional loss supporting a 10% rating (based on §4.59, §4.40 and §4.45).  There was no history or evidence of dislocated meniscus or loose body causing frequent locking with recurrent effusions (5258), history of surgery to remove a meniscus (5259), or fracture, nonunion or malunion of the femur or tibia to support consideration under the respective codes for knee impairment related to long bone conditions (5255, 5262).  There was therefore no VASRD §4.71a rating higher 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 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.  

AR20190006192, 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.