RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXX	CASE:  PD-2013-02194
BRANCH OF SERVICE:  Army	BOARD DATE: 20150212
SEPARATION DATE:  20040720

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E-4 (Motor Transport Operator) medically separated for right knee.  The condition could not be adequately rehabilitated to meet the physical requirements of his Military Occupational Specialty.  He was issued a permanent L3 profile and referred for a Medical Evaluation Board (MEB).  The “right knee post traumatic osteoarthritis” was forwarded to the Physical Evaluation Board (PEB) IAW AR 40-501.  No other condition was submitted by the MEB.  The Informal PEB adjudicated “posttraumatic arthritis right knee following ACL reconstruction” as unfitting, rated 10% with likely application of US Army Physical Disability Agency (USAPDA) pain policy.  The CI made no appeals and was medically separated.

CI CONTENTION:  “I feel my record should be reviewed because I feel the MEB was incorrect in my rating. I only received a 10% rating overall (with 2 other conditions being rated at 0%).  At the time of my medical review and while undergoing MEB proceedings, I was consistently told by my superiors in my rear detachment unit, that it would be futile to file an appeal and that if undeployable overseas, I was of no use to the military.  I do not feel that I had any representation during my MEB process and was pressured by my unit to give in and sign for the low initial rating I was granted by the board.  I feel there were many issues that were minimized or not included in my review and decision by the MEB.  In addition, the treatments for my conditions that worsened during my service times, specifically my knee, back, and headache issues, were delayed.  Regardless of my pain level and inability to properly preform my job duties and I was only given medications or physical therapy with very little difference or success achieved.  I feel the MEB board did not review my file correctly, minimizing the pain, severity, and functioning of my rated conditions.  My right knee has never been right since my injury during service.  I still walk in pain daily, can not bend my knee completely and have degenerative joint disease as a result of the injury and repair.  I have lots of internal scar tissue and it flares up regularly to the point of extreme pain at times.  My migraines began early in my Army career and progressively became worse during the course of my service and after my separation.  During my visits to sick call, while on active duty, I was told to merely take ibuprofen and rest.  Regardless of the severity and frequency of my migraines, I was discouraged from seeking any additional treatment beyond just ibuprofen and rest.  Once separated from Army service, the doctors at the VA finally realized that I needed additional powerful medicines to finally control my migraines that had plagued me for my entire Army career.”  

His complete submission is at Exhibit A.

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 when specifically requested by the CI, those conditions identified by the PEB, but determined to be not unfitting.  Any conditions outside the Board’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/Naval Records.  Furthermore, the Board’s authority is limited to assessing the fairness and accuracy of PEB rating determinations and recommending corrections, where appropriate.  The Board’s assessment of the PEB rating determinations is confined to review of medical records and all available evidence for application of the Veterans Affairs Schedule for Rating Disabilities (VASRD) standards to the unfitting medical condition at the time of separation.  The Board 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, operating under a different set of laws.  The Board gives consideration to VA evidence, particularly within 12 months of separation, but only to the extent that it reasonably reflects the severity of the disability at the time of separation. 

RATING COMPARISON:

IPEB – Dated 20040308	VA* (~1 Mos. Post-Separation)	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Posttraumatic Arthritis Right Knee Following ACL Reconstruction	5010	10%	Post Traumatic Arthritis Right Knee Status Post ACL Reconstruction	5003-5010	10%	20040817	
Other x 0 (Not In Scope)	Other x 2 	
RATING:  10%	RATING:  10%	
*Derived from VA Rating Decision (VARD) dated 20040920 (most proximate to date of separation (DOS)).

ANALYSIS SUMMARY:

Posttraumatic Arthritis Right Knee following ACL Reconstruction.  The CI underwent surgery in April 2003 for reconstruction of right knee anterior cruciate ligament (ACL) and debridement of a medial meniscus tear.  Orthopedic clinic examinations following surgery (25 June, 28 July 2003 and 25 September 2003) noted 1A Lachman (slight movement with firm endpoint indicating intact ACL) and negative anterior drawer (intact ACL), negative pivot shift (intact ACL for rotational stability), and negative McMurray (for meniscus).  At the time of the MEB narrative summary (NARSUM) examination on 23 February 2004, there was 10 degrees of limited extension, flexion to 115 degrees, and the Lachman was graded as IIA indicating moderate laxity with a firm end-point (intact but lax ligament).  Follow-up orthopedic examination on 4 May 2004 recorded improved extension with 5 degrees of limitation.  At the VA Compensation and Pension (C&P) examination on 17 August 2004, a month after separation, the gait was normal and there was no swelling or effusion of the knee.  Range-of-motion examination demonstrated full extension to 0 degrees and flexion to 110 degrees.  Movement was accompanied by report of pain.  There was no instability (negative Lachman) and the McMurray test for meniscus problems was negative.

The Board directed its attention to its rating recommendation based on the above evidence.  The PEB rated the posttraumatic arthritis of the right knee following ACL reconstruction 10% (coded 5010, arthritis due to trauma).  The VA rated the right knee (post ACL reconstruction with medial meniscus debridement and degenerative joint disease) 10% (coded 5010-5260) citing painful motion and absence of instability.  Although the MEB NARSUM examination reported 10 degrees loss of extension supporting a 10% rating for limitation of extension (diagnostic code 5261) subsequent orthopedic and VA C&P examinations did not demonstrate limited extension.  Evidence of the record supports a 10% rating for painful motion, functional loss, or symptomatic status post removal of meniscus (5259).  The MEB NARSUM examination reported some laxity of the ACL however examinations prior to and subsequent to this examination did not document significant instability or subluxation that would support a rating under the diagnostic code for recurrent subluxation or lateral instability (5257).  After due deliberation in consideration of the preponderance of the evidence, the Board concluded that there was insufficient cause to recommend a change in the PEB adjudication determination for the right 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 post traumatic arthritis of the right knee following ACL reconstruction 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 re-characterization of the CI’s disability and separation determination.

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20131104, 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, AR20150010414 (PD201302194)

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			     XXXXXXXXXXXXXXX
				     Deputy Assistant Secretary of the Army
				          (Review Boards)
						         
CF: 
(  ) DoD PDBR
(  ) DVA