RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXX	CASE:  PD-2014-00848
BRANCH OF SERVICE:  Army  	BOARD DATE:  20140911
SEPARATION DATE:  20081216

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty regular Army Soldier SPC/E-4 (14T/Patriot Operator and Maintainer) who was medically separated for a left knee condition.  The left knee condition 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 left knee condition, characterized as “left knee pain and instability associated with severe ligamentous injury and subsequent surgery for this knee” was forwarded to the Physical Evaluation Board (PEB) IAW AR 40-501.  The MEB also identified and forwarded two other conditions.  The Informal PEB adjudicated “Left knee pain, rated analogously to degenerative arthritis” as unfitting, rated at 10%, with likely application of Veterans Affairs Schedule for Rating Disabilities (VASRD).  The CI made no appeals and was medically separated.

CI CONTENTION:  “(L) Knee Surgery/Injury”.  

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 left 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 20081009	VA - (4.5 Mos. Post-Separation)	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Left Knee Pain …	5099-5003	10%	Left Knee s/p ACL and LCL Repair	5257	10%	20090430	
Other x 2 (Not in Scope)	Other x 4 	20090430	
Rating:  10%	Combined:  30%	
Derived from VA Rating Decision (VARD) dated 20090527 (most proximate to date of separation)

ANALYSIS SUMMARY:  

Left Knee Pain Condition.  The narrative summary (NARSUM) (prepared 3 months prior to separation), indicated that the CI suffer a severe left knee injury that required surgical repair in May 2008.  The MEB’s examiner noted that the CI had an antalgic gait, wearing a knee brace and that a physical therapy goniometric range-of-motion (ROM) evaluation noted his left knee flexion as 125 degrees (normal 140 degrees) and extension lacking 3 degrees (normal 0 degrees) after repetition with pain on motion.  The examiner goes on to state that the CI was “stable to Lachman (stability test), anterior/posterior drawer, had some subtle laxity to varies stress, which was comparable to his non-operative side”.  The MEB examiner stated the CI had “made a reasonable recovery, considering the magnitude of his injury” and specified restriction of “running and walking without any cutting type maneuvers”.  The physical therapist’s examination stated the Lachman’s was “1+ trace greater than right”.  

At the VA Compensation and Pension (C&P) examination (performed approximately 5 months post separation), the CI reported a primary complaint of left knee pain with some feeling of instability.  He did not complain of [left knee] giving way or locking but did used an elastic sleeve (brace) on his left knee.  The VA’s examiner noted a normal gait, that the CI’s squatting was limited to three quarters due to left knee pain; ROM was 0 degrees to 135 degrees (normal 0 degrees to 140 degrees) without pain.  The [left] knee was stable to testing of the collateral and cruciate ligaments at 0 degrees and 30 degrees; however, the CI had “2 to 3 degrees of varus movement” and pain with abducting forces.  The record contained later VA examinations with additional left knee VA ratings for painful scar (coded 7804 rated at 10%, effective May 2010) and painful motion (coded 5260 rated at 10%, effective November 2011).

The Board directs attention to its rating recommendation based on the above evidence.  The PEB rated the [left] knee for painful motion at 10% and the VA rated the [left] knee at 10% for instability at 10% based on different exams.  There was no evidence of limited motion for higher than a 10% rating for ROM and there was insufficient evidence for any instability rating higher than 10% from any exam proximate to separation.  The Board focus was on if the CI’s disability of the left knee warranted dual rating of the knee for painful motion and for instability at the time of separation.

The MEB exam clearly documented painful motion; however, the [left] knee instability was equivocal as the 2-3 degrees of varus movement and Lachman’s instability test of “1+ trace increase over right” was considered by the examiner as “comparable to his non-operative side”.  The VA examination documented minimal varies of instability (greater than the non-operated side); however, painful motion was equivocal with no pain on ROM testing (including consideration of DeLuca criteria), but pain-limited squatting.  The Board considered that the 10% criterion for instability (code 5257) is “slight” and discussed the details of the exams in evidence.  There was no recurrent subluxation, give way or locking symptoms.  Board consensus was that the instability testing proximate to separation was adjudged to not provide sufficient reasonable doubt for any additional rating of the knee.  After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the Board majority 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.  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 left knee condition and IAW VASRD §4.71a, the Board majority 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.

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20140107, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans’ Affairs Treatment Record

		
XXXXXXXXXXXXXXXXX
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 XXXXXXXXXXXXXXXXX, AR20150006620 (PD201400848)

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