RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:	CASE:  PD1201095
BRANCH OF SERVICE: Army	BOARD DATE:  20130416
SEPARATION DATE:  20020719

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty PVT/E-2 (12C/Basic Trainee) medically separated for a left knee condition.  The CI sustained a twisting injury to her left knee the day she began basic training.  The knee condition could not be adequately rehabilitated to meet the physical requirements of basic training, her Military Occupational Specialty (MOS), or satisfy physical fitness standards.  She was issued a permanent L3 profile and referred for a Medical Evaluation Board (MEB).  The knee condition, characterized as severe left knee pain and anterior cruciate ligament (ACL) deficient left knee, was forwarded to the Physical Evaluation Board (PEB) IAW AR 40-501.  No other conditions were submitted by the MEB.  The Informal PEB (IPEB) combined the two MEB conditions and adjudicated anterior cruciate (AC) deficient left knee as unfitting, rated 20%, with application of the Veteran’s Affairs Schedule for Rating Disabilities (VASRD).  The CI made no appeals, and was medically separated with a 20% disability rating.

CI CONTENTION:  The CI elaborated no specific contention in her application.  

SCOPE OF REVIEW: The Board’s scope of review is defined in DoDI 6040.44, Enclosure 3, paragraph 5.e.(2).  It is limited to those conditions determined by the PEB to be unfitting for continued military service and those conditions identified but not determined to be unfitting by the PEB when specifically requested by the CI.  The rating for the unfitting knee condition is addressed below; and, no additional conditions are within the DoDI 6040.44 defined purview of the Board.  Any conditions or contention not requested in this application, or otherwise outside the Board’s defined scope of review, remain eligible for future consideration by the Board for Correction of Military Records.

RATING COMPARISON:  
   
Service IPEB – Dated 20020613	VA - based on Service Treatment Record (STR)	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Left Knee, Anterior Cruciate Deficient	5257	20%	Left Knee DJD	5257-5010	10%	STR	
			Left Knee, Anterior Cruciate Deficient	5257	10%	STR	
No Additional MEB/PEB Entries	Other x 0		
Combined:  20%	Combined:  20%	
Derived from VA Rating Decision (VARD) dated 20021011 (most proximate to date of separation [DOS]).   

ANALYSIS SUMMARY:  
 
Left knee pain.  The CI injured her left knee on the first day of basic training.  Magnetic resonance imaging (MRI) was consistent with ACL tear, and early degenerative joint disease (DJD).  She was treated, but her knee pain persisted and an MEB was initiated.  The MEB clinical evaluation was on 7 May 2002.  On physical examination (PE), the CI was in no apparent distress.  Left knee range-of-motion (ROM) was from 0 to 120 degrees. There was some tenderness to palpation (TTP) at the medial and lateral patellar facets.  She had pain with patellar compression, but the patellar tendon was nontender.  She had normal patellar glide and tilt, but an increased Q-angle.  There was a positive Lachman, pivot shift, and anterior drawer; with signs of ACL disruption.  Tests for varus/valgus laxity were negative.

The Board carefully reviewed all evidentiary information available, and directs attention to its rating recommendation based on the above evidence.  The Army PEB coded the left knee condition 5257 (knee, other impairment of) and assigned a rating of 20% (moderate).  The VA chose a different coding option, but also assigned a combined rating of 20% for the left knee. Based on the evidence in the service treatment (STR) record, the Board unanimously agreed that the CI’s left knee impairment was best described as “moderate.”  There was insufficient evidence to support classifying the condition as “severe.”  After due deliberation, the Board determined that a separation disability rating of 20% was warranted, due to the moderate left knee impairment.  The Board tried to find a path to a rating higher than 20%, using other codes which could be applied to the left knee condition.  The other VASRD codes that were considered did not result in a rating higher than 20%, since the STR did not show sufficient evidence of a disabling joint abnormality which would justify a rating higher than 20%. Considering all of the evidence and mindful of VASRD §4.3 (resolution of reasonable doubt), the Board concluded that there was insufficient cause to recommend a change in the PEB adjudication for the left knee condition.

BOARD FINDINGS:  IAW DoDI 6040.44, provisions of DoD or Military Department regulations or guidelines relied upon by the PEB will not be considered by the Board to the extent they were inconsistent with the VASRD in effect at the time of the adjudication.  In the matter of the left knee condition and IAW VASRD §4.71a, the Board unanimously recommends no change in the PEB adjudication.  There were no other conditions within the Board’s scope of review for consideration.

RECOMMENDATION:  The Board, therefore, recommends that there be no recharacterization of the CI’s disability and separation determination, as follows:  

UNFITTING CONDITION	VASRD CODE	RATING	
Left knee pain, with anterior cruciate ligament deficiency	5257	20%	
COMBINED	20%	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20120709, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans’ Affairs Treatment Record

	Physical Disability Board of Review

SFMR-RB									

MEMORANDUM FOR Commander, US Army Physical Disability Agency 
(TAPD-ZB ),

SUBJECT:  Department of Defense Physical Disability Board of Review Recommendation for AR20130009471 (PD201201095)

I have reviewed the enclosed Department of Defense Physical Disability Board of Review (DoD PDBR) recommendation and record of proceedings pertaining to the subject individual.  Under the authority of Title 10, United States Code, section 1554a,   I accept the Board’s recommendation and hereby deny the individual’s application.  
This decision is final.  The individual concerned, counsel (if any), and any Members of Congress who have shown interest in this application have been notified of this decision by mail.

 BY ORDER OF THE SECRETARY OF THE ARMY:

Encl						
						         (Army Review Boards)

CF: 
(  ) DoD PDBR
(  ) DVA