RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD1300092
BRANCH OF SERVICE: NAVY	BOARD DATE:  20130910
SEPARATION DATE:  20010926

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty MM1/E-6 (Machinist’s Mate) medically separated for a left knee condition.  He was initially injured in 1991 with continued episodes of instability, pain, and swelling of the knee.  The knee required surgical fixation in 1994 and the CI went back to full activities after rehabilitation.  The CI sustained another injury to his knee in 2001 and the condition could not be adequately rehabilitated to meet the physical requirements of his rating or satisfy physical fitness standards.  He was placed on limited duty and referred for a Medical Evaluation Board (MEB).  The left knee condition, characterized as left knee severe degenerative joint disease (DJD), left knee anterior cruciate ligament insufficiency, left knee lateral meniscus tear and medial meniscus tear, was forwarded to the Physical Evaluation Board (PEB) IAW SECNAVINST 1850.4E.  No other conditions were submitted by the MEB.  The PEB adjudicated left knee severe DJD as unfitting, rated 10%, with likely application of the Veterans Affairs Schedule for Rating Disabilities (VASRD).  The remaining conditions were determined to be Category II (contributing to unfitting condition).  The CI made no appeals and was medically separated.

CI CONTENTION:  “I have found that the injuries I sustained while on active duty which required surgery (left knee and lower back) continue to bother me on a daily basis.  Namely knee and back pain probably due to arthritis.”

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.  The requested low back condition was not identified by the PEB, and thus is not 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 Naval Records.

RATING COMPARISON:

Service IPEB – Dated 20010830	Based on Service Treatment Records (STR)	
Condition	Code	Rating	Condition	Code	Rating	Exam	
L/Knee Severe DJD	5003	10%	DJD, L/Knee	5003	0%	STR	
L/Knee Lateral Meniscus Tear Treated Surgically	CAT II	No VA Entry	
Medial Meniscus Tear Treated Surgically	CAT II	No VA Entry	
L/Knee ACL Insufficiency Treated Surgically	CAT II	No VA Entry	
No Additional MEB/PEB Entries	Other x 1	STR	
Combined:  10%	Combined:  0%	
Derived from VA Rating Decision (VARD) dated 20020912 (most proximate to date of separation [DOS]).   CI failed to report for VA C&P exams on 20011128, 20020304, 20020327 and 20020329.
ANALYSIS SUMMARY:

Left Knee Condition.  The first entry in the service treatment record (STR) is from December 1991 after a football injury.  He subsequently re-injured his knee.  He then had arthroscopic surgeries on 13 July 1994 (meniscectomy), and 12 September 1994 (anterior cruciate ligament [ACL] repair).  He had further knee re-injuries after the first two surgeries.  He had a third left knee arthroscopic surgery on 20 April 2001 for debridement, and lateral meniscectomy.  The operative report described severe chondromalacial changes in the lateral compartment with osteophytic ridging in the patellofemoral joint, medial, and lateral compartments, extensive degenerative tear of the lateral meniscus, and an intact ACL graft.

The medical board examination on 3 May 2001, 4 months prior to separation and 2 weeks after his second left knee surgery, noted that the CI had been returned to duty on 16 August 1993; which was twice prior by MEB for lumbar spine surgery and 6 April 1995 for the left knee ACL repair.  The CI continued to have knee pain similar to his preoperative symptoms with flexion of the left knee.  He was unable to run, jump or perform any heavy activities; he had pain with prolonged walking and standing.  He was limited from running, jumping, physical readiness testing, squatting, crawling and deployment aboard ships or submarines.  Physical examination revealed well-healed surgical scars, some lateral joint line tenderness to palpation with a negative McMurray’s test (for meniscal tears), and a 1+ Lachman’s (mild ACL instability), no varus or valgus instability.  Ranges-of-motion (ROM) were flexion 110 degrees (normal 140) with pain, and extension 5 degrees (normal 0).  An addendum, performed 3 months after surgery, on 10 July 2001, 2 months prior to separation, revealed no change clinically and physical examination showed 1+ Lachman’s with soft endpoint and negative pivot shift, no instability, lateral joint line tenderness, pain and crepitus along the lateral joint line with McMurray’s maneuver for meniscal tears, crepitus, neurovascularly intact.  ROMs were flexion 120 (normal 140) with pain as an end point of flexion along the lateral knee joint and extension was 5 degrees (normal 0).  There was no Compensation and Pension examination in the record, and the VA rating was based on the STR.

The Board directs attention to its rating recommendation based on the above evidence.  The Board considered VASRD code 5003 (degenerative arthritis), used by both the PEB for a 10% rating, and the VA for a 0% rating.  The Board noted that there was no compensable limitation of motion under knee codes 5260 (leg, limitation of flexion of); or 5261 (leg, limitation of extension of).  The Board did not find clinical evidence of dislocated knee, frequent episodes of ‘‘locking’’ pain, or effusion into the joint, for a higher adjudication using codes 5256 (knee, ankylosis of); 5257 (knee, other impairment of); or 5258 (cartilage, semilunar, removal of, symptomatic).  There was satisfactory evidence of painful motion at the ROM examination, as well as surgical evidence of severe arthritis, for a 10% 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 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 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 Severe Degenerative Joint Condition	5003	10%	
COMBINED	10%	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20130225, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans’ Affairs Treatment Record

MEMORANDUM FOR DIRECTOR, SECRETARY OF THE NAVY COUNCIL OF REVIEW 
                                        BOARDS 

Subj:  PHYSICAL DISABILITY BOARD OF REVIEW (PDBR) RECOMMENDATIONS
 
Ref:   (a) DoDI 6040.44
          (b) CORB ltr dtd 17 Dec 13

      In accordance with reference (a), I have reviewed the cases forwarded by reference (b), and, for the reasons provided in their respective forwarding memorandums, approve the recommendations of the PDBR that the following individual’s records not be corrected to reflect a change in either characterization of separation or in the disability rating previously assigned by the Department of the Navy’s Physical Evaluation Board:

- XXXXXXXXXXXXXXXXXX former USN