RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2017-05675
BRANCH OF SERVICE:  Army	SEPARATION DATE:  20080821

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

CI CONTENTION:  In addition to a more severe knee condition the CI also requested review of additional conditions not identified by the Medical Evaluation Board (MEB) and Physical Evaluation Board (PEB).  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 PEB to be unfitting for continued military service, and when specifically requested by the CI, those conditions identified by the 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 - 20080506	VARD - 20080822	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Left Knee, Removal of Meniscal Fragments on Two Occasions with Persistent Pain…	5259	10%	Traumatic Arthritis, Left Knee	5010-5260	10%	20080808	
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 underwent an arthroscopic surgery for a ruptured anterior cruciate ligament (ACL) and meniscal tears in June 2006, and in February 2007 underwent ACL reconstruction.  Chondromalacia was noted during surgery.  In November 2007, due to continued pain, he underwent arthroscopy to debride a tear of the lateral meniscus.  During the 25 January 2008 MEB examination (recorded on DD Forms 2807-1 and 2808), 7 months prior to separation, physical examination revealed tenderness around the left knee joint line without evidence of edema, ecchymosis, or erythema.  Deep tendon reflexes and muscle strength were normal.  The 31 January 2008 MEB NARSUM examination noted complaints of continued left knee pain.  Pain was noted with push-off, stairs, quickly moving from a standing or stationary position, and increased activity.  Physical examination of the left knee showed no gross effusion, crepitus, or patellofemoral compression.  The left quadriceps muscle was smaller than the right (42 cm versus 46 cm).  There was tenderness at the lateral joint line and the insertion of the lateral hamstrings.  Range of motion (ROM) was flexion of 118 degrees (normal 140) and normal 0- degree extension.

At the 8 August 2008 VA Compensation and Pension (C&P) examination, the month prior to separation, the CI reported daily pain, with weakness, stiffness, swelling, instability, giving way, locking, catching, fatigability, and lack of endurance.  Precipitating factors were sitting, standing, walking, kneeling, crawling, squatting, hills/inclines, and uneven going and stairs.  The CI had been seeking a knee brace.  Physical examination showed ROM measured with a goniometer with flexion of 120 degrees and extension of 0 degrees.  There was painful motion.  Following repetition, there was no additional limitation by pain, fatigue, weakness, incoordination or lack of endurance.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the left knee condition 10%, coded 5259 (cartilage, semilunar, dislocation, with frequent episode of locking), citing no instability, with flexion 0 to 120 degrees.  The VA rated the left knee traumatic arthritis condition 10%, analogously coded 5010-5260 (arthritis, due to trauma-leg, limitation of flexion) based on the C&P examination, citing objective evidence of painful motion.  There was no limitation of motion which supported a rating under the diagnostic codes for limitation of flexion or extension (5260, 5261).  However, the 5259 code was applicable in this case with the maximum 10% rating as adjudicated by the PEB, and meniscal coding includes painful motion.  There was no history of dislocated meniscus or loose body causing frequent locking with recurrent effusions (5258) to support a higher rating under that code.  There was no 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).  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 left knee pain condition.  

BOARD FINDINGS:  In the matter of the left knee meniscal condition and IAW VASRD §4.71, 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, XXXXXXXXXXXXX 

Dear XXXXXXXXXX:

	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