RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXX	CASE:  PD-2013-02750
BRANCH OF SERVICE:  Army	BOARD DATE:  20141121
SEPARATION DATE:  20070121

SUMMARY OF CASE: Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty Army SPC/E-4 (21E10/Heavy Construction Equipment Operator) medically separated for a knee condition.  It could not be adequately rehabilitated to meet the physical requirements of his Military Occupational Specialty or satisfy physical fitness standards.  He was issued a permanent L3 profile and referred for a Medical Evaluation Board (MEB).  The knee condition, characterized as “residual right knee pain s/p right ACL reconstruction,” was forwarded to the Physical Evaluation Board (PEB) IAW AR 40-501.  No other conditions were submitted by the MEB or considered by the PEB.  The Informal PEB adjudicated “residual right knee pain, post ACL reconstruction” as unfitting, rated 10% with likely application of the VA Schedule for Rating Disabilities (VASRD).  The CI made no appeals and was medically separated.

CI CONTENTION:  “Because I was rated by Dod 20% but I am rated 90% plus w/VARD.”

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; 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 20061117	VA - (9  Mos. Post-Separation)  	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Residual Right Knee Pain, Post ACL Reconstruction	5257	10%	Rupture, ACL Right Knee Post Repair with Scars	5299-5260	10%	20071023	
Other x 0  (Not in Scope)	Other x 5 	
Rating:  10%	Combined:  50%	
Derived from VA Rating Decision (VARD) dated 20071205 (most proximate to date of separation)

ANALYSIS SUMMARY:  The Disability Evaluation System (DES) is responsible for maintaining a fit and vital fighting force.  While the DES considers all of the member's medical conditions, compensation can only be offered for those medical conditions that cut short a member’s career, and then only to the degree of severity present at the time of final disposition.  The DES has neither the role nor the authority to compensate members for anticipated future severity or potential complications of conditions resulting in medical separation nor for conditions determined to be service-connected by the Department of Veterans Affairs (DVA) but not determined to be unfitting by the PEB.  However, the DVA, operating under a different set of laws (Title 38, United States Code), is empowered to compensate all service-connected conditions and to periodically re-evaluate said conditions for the purpose of adjusting the Veteran’s disability rating should the degree of impairment vary over time.  The Board’s role is confined to the review of medical records and all evidence at hand to assess the fairness of PEB rating determinations, compared to VASRD standards, based on severity at the time of separation.

Residual Right Knee Pain Condition.  The CI was first evaluated for right knee pain on 12 May 2005 when he reported 2-day history of right knee pain after combative training.  He did not improve with duty restrictions and medications which led to a magnetic resonance imaging (MRI) on 9 June 2005.  The MRI showed normal collateral ligaments (on each side of the knee), but degenerative changes in the menisci (cartilage cushions in the knee), and a possible sprain of the anterior cruciate ligament (ACL; one of two ligaments inside the knee which provide forward and backward stability).  He continued conservative treatment including physical therapy, but had ongoing pain and occasional buckling of the right knee.  An orthopedic evaluation (dated omitted) showed ACL instability which was confirmed at arthroscopy performed 16 March 2006 when it was repaired.  Degeneration of the medial meniscus was also noted, but the examination was otherwise normal without further instability or loose bodies present.  He did not improve sufficiently for full duty and was entered into the MEB process.  

At the MEB examination on 20 July 2006 (6 months prior to separation), the CI reported that his knee continued to “give out” and that he could not bend down or step up.  The examiner noted an anterior drawer sign which indicated laxity of the ACL, but it was not quantified.  The knee was tender overall and painful to flexion.  No range-of-motion (ROM) was recorded.  The MEB ROM was accomplished in physical therapy on 21 September 2005 and is recorded below.  The narrative summary was dated 5 October 2005 and based on an examination on 30 September 2005.  It noted that the CI had been sent into the field 6 weeks after the surgery and had missed several physical therapy appointments.  On examination, slight laxity of the ACL was present on one maneuver, but not on another.  No other testing for instability was positive and there was no swelling.  He was tender over the kneecap.  Signs of meniscal irritation were not present.  Further improvement was anticipated with both decreased activity and continued rehabilitation.  

At the VA Compensation and Pension examination performed on 8 December 2006 (9 months after separation), the CI reported that he could not sit with it flexed or straighten it fully.  He denied locking and the use of assistive devices, although he did use the handrails going down stairs.  He could walk about one mile and could drive although he needed to keep the knee stretched out.  On examination, his gait was noted to be “stiff” secondary to the right knee.  The knee was stable to examination although movement aggravated the tenderness about the kneecap.  Specific testing for meniscal irritation was negative although tenderness along the medial joint line was present (frequently present with meniscal injury, but not diagnostic).  The goniometric 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)	PT ~ 4 Mo. Pre-Sep	VA C&P ~ 9 Mo. Post-Sep	
Flexion (140 Normal)	120	122	
Extension (0 Normal)	0	0	
Comment	--	Left knee full ROM	
§4.71a Rating	10%	10%	

The Board directed its attention to its rating recommendation based on the above evidence.  The PEB and VA both rated the right knee at 10%, but used different coding options, respectively, 5257 (other impairment of the knee), and 5299-5260 (limitation in flexion).  The Board considered these and other coding options for the knee, but absent locking, ratable limitation in motion, or further meniscal injury, it found no route to a higher rating.  After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the Board concluded that there was insufficient cause to recommend a change in the PEB adjudication for the right knee condition.  There were no other conditions within the Board’s scope of review for consideration.

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.  The Board did not surmise from the record or PEB ruling in this case that any prerogatives outside the VASRD were exercised.  In the matter of the residual right knee pain 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 20111219, 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, AR20150007066 (PD201302750)

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