RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2017-05587
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20050515

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E-4, Petroleum Supply Specialist, medically separated for “left knee pain” with a disability rating of 10%.    

CI CONTENTION:  “Left MCL, PCL, ACL surgery/only got 20%.”  “Knee unstable.”  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 - 20050331	VARD - 20050811	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Left Knee Pain…with Subjective Instability but Firm Endpoint	5003	10%	Status Post Operative Left Knee with Osteoarthritis and Scar	5257-5003	10%	STR	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  10% 	

ANALYSIS SUMMARY:  

Left Knee Pain with Subjective Instability but Firm Endpoint.  According to the service treatment record (STR) and MEB narrative summary (NARSUM), the CI sustained an injury to his left knee in March 2003 and subsequently underwent an anterior cruciate ligament (ACL) reconstruction in August 2003.  Despite surgery and extensive rehabilitation, the CI continued to note significant pain and swelling within his knee as well as inability to return to full activity.  Repeat radiologic examinations performed in mid-2004 revealed the ACL to be intact with evidence of mild degenerative changes in the left knee joint.

During the 15 November 2004 MEB examination (recorded on DD Forms 2807-1 and 2808), 6 months prior to separation, the physical examination (PE) noted left knee range of motion (ROM) to 120 degrees of flexion (normal 140) and normal extension.  Additionally, tenderness about the knee joint was present without evidence of joint instability.  There was no comment with regard to painful motion.    
At the 22 March 2005 MEB NARSUM examination, 2 months prior to separation, the CI endorsed constant left knee pain with a “subjective” feeling of instability, particularly with walking on uneven surfaces.  Additionally, he complained of intermittent left knee swelling and pain particularly with prolonged sitting or with impact activity.  The CI used a knee brace for comfort and for a feeling of stability.  The focused PE revealed normal left knee extension and painful flexion to 130 degrees.  Mild diffuse tenderness was present about the left knee.  Multidirectional tests for joint instability were negative indicating a stable knee joint.  

There was no VA Compensation and Pension (C&P) examinations proximate to separation in evidence. Therefore, this panel’s impairment recommendation will be based upon the STR as well as MEB-driven documents.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB and VA both rated the left knee condition at 10%, coded 5003 (degenerative arthritis).  The PEB citied subjective instability with firm endpoint and ROM limited by pain.  The VA also utilized a dual code of 5257 (knee; other impairment) as well as 5003, and based the 10% rating on the STR, citing painful or limited motion of a major joint or group of minor joints, with application once to multiple joints in the absence of limited or painful motion.

Panel members first acknowledged that the pre-separation PEs as referenced above revealed non-compensable ROM parameters and only the evidence of painful motion as seen at the NARSUM 2 months prior to separation would support no greater than a 10% rating IAW VASRD §4.59.  Panel members also acknowledged that the CI’s extensive surgery included meniscal debridement and therefore, VASRD code 5259 (cartilage, semilunar; removal) was supported at the sole rating of 10%.  However, rating under 5259 provided no greater benefit to the CI than that of VASRD §4.59 or of the PEB’s current code of 5003.  The panel considered other VASRD knee and analogous codes, but these were less applicable and/or not advantageous for rating. Therefore, 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’s adjudication for the left knee condition.

BOARD FINDINGS:  In the matter of the left knee pain 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.  

ARXXXXXXXXXXX, XXXXXXXXXXXXXX 

Dear XXXXXXXXXXXX:

	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.