RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXXX	CASE:  PD-2013-01745
BRANCH OF SERVICE:  NAVY	BOARD DATE:  20150320
SEPARATION DATE:  20040531

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E-5 (Nuclear Mechanic) medically separated for bilateral knee pain.  The bilateral knee conditions 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 knee condition, characterized as “bilateral anterior knee pain” was forwarded to the Physical Evaluation Board IAW SECNAVINST 1850.4E.  No other conditions were submitted by the MEB.  The Informal PEB adjudicated “bilateral anterior knee pain secondary to patellar malalignment syndrome” as unfitting, rated 10% for each knee with likely application of the Veterans Affairs Schedule for Rating Disabilities (VASRD). The CI made no appeals and was medically separated.

CI CONTENTION:  “As shown on enclosed VA rating documents of same period, VA rating for separation injuries awarded at 40%-55% revised total disability.”

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 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:

Navy IPEB – dated 20040408	VA – (2 weeks Pre-Separation)	
Condition	Code	Rating	Condition	Code	Rating	Exam	

Bilateral Anterior Knee Pain Secondary To Patellar Malalignment Syndrome
	5099-5003	10%	Status Post Recurrent Patellar Dislocations, with Degenerative Arthritis Post Surgery, Right Knee	5258	20%	20040518	
	5099-5003	10%	Status Post Recurrent Patellar Dislocations, with Degenerative Arthritis Post Surgery, Left Knee	5258	20%	20040518	
Other x 0  (Not in Scope)	Other x 4	
Combined Rating:  20%	Combined Rating:  50%	
Derived from VA Rating Decision (VARD) dated 20040622 (most proximate to date of separation [DOS])

ANALYSIS SUMMARY:

Knee Pain.  The CI has had a long history of knee problems.  In 2002, he underwent bilateral patellar realignment procedures for recurrent dislocations.  After surgery, he did not have any further episodes of dislocation, but had progressive bilateral knee pain.  He had difficulty ascending and descending ladders, which caused significant problems on the submarine.  He was treated with physical therapy and anti-inflammatory medications.  However, his knee pain persisted and a MEB was initiated.  At the MEB physical examination (PE), the CI was alert and in no apparent distress.  On PE of the knees, there was tenderness to palpation at the medial patellar facet bilaterally.  There was no effusion, no instability, and Lachman’s test was negative.  The patella’s tracked well.  Range-of-motion (ROM) was 0-130 degrees on the left, and 0-125 degrees on the right.  Both legs were neurovascularly intact.

The CI was medically separated from service on 31 May 2004.  On 18 May 2004, 2 weeks prior to separation, he had a VA Compensation and Pension (C&P) exam.  He was using a cane for ambulation.  However, on PE, his gait was within normal limits.  PE of the knees showed some swelling bilaterally.  Drawer testing and McMurray testing was normal.  Left knee ROM was 0-140 degrees, and right knee ROM was 0-130 degrees.  On neurological exam, there was no muscle weakness.  Motor function of both legs was normal.  Both knees had “locking” pain, joint effusion, and crepitus.  The ROM evaluations which the Board weighed in arriving at its rating recommendation are summarized in the chart below.

Knee ROM
(Degrees)	
MEB ~ 3 mos. Pre-Sep
	
VA C&P ~ 2 weeks Pre-Sep
	
	Left	Right	Left	Right	
Flexion (140 Normal)	130	125	140	130	
Extension (0 Normal)	0	0	0	0	

The Board directed attention to its rating recommendation based on the above evidence.  The PEB and the VA chose different coding and rating options for the knee condition.  The PEB used VASRD code 5099-5003 (analogous to degenerative arthritis) and rated each knee at 10% based on non-compensable, painful limitation of motion IAW the VASRD.  The VA coded it 5258 (cartilage, semilunar, dislocated) and assigned a rating of 20% to each knee.  At the May 2004 C&P exam, the examiner indicated that both knees had “locking” pain, joint effusion, and crepitus.  The Board deliberated at length, with regard to what was meant by this statement.  Based on a thorough review of the treatment record, the Board found insufficient evidence to support a conclusion that the CI had injury to his semilunar cartilages (menisci).  Therefore, VASRD code 5258 was not considered applicable.

The Board reviewed the ROM data, and determined that the painful knee condition was essentially non-compensable based solely on the VASRD §4.71a diagnostic codes for loss of knee motion (5260 and 5261).  However; IAW VASRD §4.40, §4.45, and §4.59, when part of the musculoskeletal system becomes painful on use, it must be regarded as seriously disabled.  A 10% rating is warranted when there is satisfactory evidence of functional limitation due to painful motion of a major joint.  There was no path to a rating higher than 10% for either knee since there was insufficient evidence of ligamentous instability, subluxation, or other serious joint abnormality that would justify a higher rating.  After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the Board found insufficient cause to recommend a change in the PEB adjudication for the unfitting bilateral anterior knee pain.

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 bilateral anterior knee pain and IAW VASRD §4.40, §4.45, and §4.59, 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 20130930, 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) RECOMMENDATION 
Ref:	(a) DoDI 6040.44
(b) CORB ltr dtd 2 Jul 15

In accordance with reference (a), I have reviewed the cases forwarded by reference (b), and, for the reasons provided in their 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:

-	XXXXXXXXXXXXXXXXXXXX, former USN
-	XXXXXXXXXXXXXXXXXXXX, former USN
-	XXXXXXXXXXXXXXXXXXXX, former USN
-	XXXXXXXXXXXXXXXXXXXX, former USN
-	XXXXXXXXXXXXXXXXXXXX, former USMC
-	XXXXXXXXXXXXXXXXXXXX, former USMC