RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  xxxxxxxxxxxxxxxxxxx	CASE:  PD-2017-06139
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20060416

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E4, Power Generator Equipment Repairman, medically separated for “chronic pain right knee, status post ACL [anterior cruciate ligament] reconstruction and partial medial meniscectomy, without instability” with a disability rating of 10%.  

CI CONTENTION:  “Persistent pain requiring training in non-physical types of labor.”  The CI 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 - 20060124	VARD - 20070821	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Pain Right Knee	5099-5003	10%	Status Post Surgical Changes of the Right Knee 	5257-5010	10%	20070723	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  10% 	

ANALYSIS SUMMARY:  

Chronic Pain Right Knee.  According to the service treatment record and MEB narrative summary (NARSUM), the CI underwent ACL reconstruction with hamstring tendon and medial meniscal repair.  The meniscal tear did not heal and the CI underwent a second operation (partial medial meniscectomy) in June 2005.  Post-surgical X-rays showed soft tissue swelling and joint effusion.    
The 28 October 2005 MEB examination (recorded on DD Forms 2807-1 and 2808), 6 months prior to separation, revealed only 50% of right knee range of motion (ROM) with pain throughout ROM.  During the 9 November 2005 MEB NARSUM examination, 5 months prior to separation, the CI complained of pain associated with popping and clicking in his right knee.  Physical examination showed joint line tenderness, but no instability.  Right knee ROM testing showed flexion of 115 degrees (normal 140) and extension of 0 degrees (normal).  

At the 23 July 2007 VA Compensation and Pension (C&P) examination, 15 months after separation, the CI reported right knee pain with prolonged sitting and flares six times a day for which he used a brace.  Physical examination showed an antalgic gait and crepitus.  There was no increased heat, erythema, edema or effusion.  The knee was stable.  Right knee ROM, following repetitive movement, was flexion of 140 degrees and extension of 0 degrees with painful motion.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the right knee condition 10%, analogously coded 5003 (degenerative arthritis), citing slight and constant pain IAW the US Army Physical Disability Agency pain policy.  The VA also rated the right knee condition 10%, dual coded 5257-5010 (knee, other impairment of - arthritis, due to trauma), based on the C&P examination, citing painful or limited motion of a major joint.  

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).  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 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 route to a 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.  

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Dear xxxxxxxxxxx:

	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.