RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXX	CASE:  PD-2013-01543
BRANCH OF SERVICE:  Army	BOARD DATE:  20141028
SEPARATION DATE:  20041228

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty SPC/E-4 (91K/Medical Laboratory Specialist) medically separated for a right knee condition.  The condition could not be adequately rehabilitated to meet the physical requirements of her Military Occupational Specialty or satisfy physical fitness standards.  She was issued a permanent L3 profile and referred for a Medical Evaluation Board (MEB).  The condition, characterized as “right knee anterior cruciate ligament (ACL) deficiency,” was forwarded to the Physical Evaluation Board (PEB) IAW AR 40-501.  No other conditions were submitted by the MEB.  The Informal PEB adjudicated “right knee injury” as unfitting, rated 0%, with cited application of the US Army Physical Disability Agency (USAPDA) pain policy.  The CI made no appeals and was medically separated.

CI CONTENTION:  “When I entered the military, I was a healthy 25 year old young lady.  I had never had any broken bones or any types of surgery.   It took nearly 3 months before I knew the extent of my injury and found out that the only way to correct my injury was through surgery…I just worry sometimes.  Additionally, the CI attached a one page statement to her application which was reviewed by the Board and considered in its recommendations.

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 right knee condition is addressed below; 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 20041124	VA - (5 Mos. Post-Separation)	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Right Knee Injury	5099-5003	0%	s/p Anterior Cruciate Ligament Tear Right Knee	5260	0%	20050326	
Other x 0 (Not in Scope)	Other x 0	
Combined:  0%	Combined:  0%	
Derived from VA Rating Decision (VARD) dated 20050601(most proximate to date of separation [DOS])

ANALYSIS SUMMARY:  IAW DoDI 6040.44, the Board’s authority is limited to making recommendations on correcting disability determinations.  The Board’s role is thus confined to the review of medical records and all evidence at hand to assess the fairness of PEB rating determinations, compared to Veterans Affairs Schedule for Rating Disabilities (VASRD) standards, based on ratable severity at the time of separation.

Right Knee Condition.  The CI suffered a right knee injury during basic training in March 2004.  She felt a “pop” had immediate pain with swelling and was initially treated with physical therapy.  A magnetic resonance imaging scan performed a month later revealed a bone contusion and suspected ACL tear.  Orthopedic evaluation for right knee instability was accomplished and the CI underwent ACL reconstruction on 17 June 2004.  Her post-operative physical therapy went well and all exams after surgery documented no instability.  The narrative summary prepared 3 months prior to separation noted “…pain rating under American Medical Association is constant and slight, and she has been doing very well and being compliant with her rehabilitation protocol to date.”  The pertinent physical exam findings are summarized in the chart below.  The VA Compensation and Pension exam performed 3 months after separation contained the following statement:

“…currently, she is an assembler and makes axels.  She does a lot of standing all day long.  She says the knee stiffens up on her some if she stays in one position too long such as prolonged standing, prolonged sitting.  She has some trouble with stairs with some aching. She does not have enough pain that cause her to take any medicine or any injections.  She states the knee does not give out, swell or lock up on her at this point.”

The goniometric range-of-motion (ROM) evaluations in evidence which the Board weighed in arriving at its rating recommendation, with documentation of additional ratable criteria, are summarized in the chart below.

Right Knee ROM (Degrees)	NARSUM ~3 Mo. Pre-Sep	VA C&P ~3 Mo. Post-Sep	
Flexion (140 Normal)	135	135	
Extension (0 Normal)	0	0	
Comment	Normal gait; No effusion; No instability; Still in rehabilitation; Constant, slight pain	Normal gait; No effusion; No instability No Deluca criteria	
§4.71a Rating	10%*	0% (VA 0%)	
* IAW VASRD §4.59, Painful motion

The Board directs attention to its rating recommendation based on the above evidence.  The PEB applied the analogous VASRD code of 5099-5003 (degenerative arthritis) and rated at 0% citing the USAPDA pain policy.  The VA used code 5260 (limitation of leg flexion) and rated at 0%.  All exams performed proximate to separation demonstrated non-compensable ROM measurements and no indication of instability as required for application of a knee specific code.  There was evidence of joint disease, CI underwent ACL reconstruction, there was satisfactory evidence of painful motion IAW §4.59 and evidence of functional loss IAW §4.40 contained in the evidence.  After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), §4.59 and §4.40, the Board recommends a disability rating of 10% for the right knee injury 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.  As discussed above, PEB reliance on the USAPDA pain policy for rating right knee injury condition was operant in this case and the condition was adjudicated independently of that policy by the Board.  In the matter of the right knee injury condition, the Board unanimously recommends a disability rating of 10%, coded 5099-5003 IAW VASRD §4.71a.  There were no other conditions within the Board’s scope of review for consideration.

RECOMMENDATION:  The Board recommends that the CI’s prior determination be modified as follows, effective as of the date of her prior medical separation:

UNFITTING CONDITION	VASRD CODE	RATING	
Right Knee Injury	5099-5003	10%	
COMBINED	10%	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 201309018, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans’ Affairs Treatment Record

XXXXXXXXXXXXXXX
President
Physical Disability Board of Review

SAMR-RB									

MEMORANDUM FOR Commander, US Army Physical Disability Agency 
(AHRC-DO), 2900 Crystal Drive, Suite 300, Arlington, VA  22202-3557

SUBJECT:  Department of Defense Physical Disability Board of Review Recommendation 
for XXXXXXXXXXXXXXX, AR20150007005 (PD201301543)

1.  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 to modify the individual’s disability rating to 10% without recharacterization of the individual’s separation.  This decision is final.  

2.  I direct that all the Department of the Army records of the individual concerned be corrected accordingly no later than 120 days from the date of this memorandum.   

3.  I request that a copy of the corrections and any related correspondence be provided to the individual concerned, counsel (if any), any Members of Congress who have shown interest, and to the Army Review Boards Agency with a copy of this memorandum without enclosures.

BY ORDER OF THE SECRETARY OF THE ARMY:

Encl		     XXXXXXXXXXXXXXX
			     Deputy Assistant Secretary of the Army
			         (Review Boards)

CF: 
(  ) DoD PDBR
(  ) DVA