RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXXX	CASE:  PD-2013-01747
BRANCH OF SERVICE:  NAVY	BOARD DATE:  20150721
SEPARATION DATE:  20060106

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E-4 (Relational Supply Unit Technical Specialist) medically separated for a right knee condition.  The right knee 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 (LIMDU) and referred for a Medical Evaluation Board (MEB). “Tear of medial cartilage or meniscus of knee, current,” “other acquired deformities of knee” and “other symptoms referable to lower leg joint,” was forwarded to the Physical Evaluation Board (PEB) IAW SECNAVINST 1850.4E.  No other condition was submitted by the MEB.  The Informal PEB adjudicated “s/p [status post] ACL [anterior cruciate ligament] reconstruction right knee” as unfitting, rated 20% with “chondral defect to his medial femoral condyle” and “bucket-handle medial meniscus tear” as related category 2 diagnoses, with likely application of the Veterans Affairs Schedule for Rating Disabilities (VASRD).  The CI made no appeals and was medically separated.  

CI CONTENTION:  His condition continues to worsen and negatively impacts his daily activities.  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 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 20051128	VA* - (~3 Years Post-Separation) 	
Condition	Code	Rating	Condition	Code	Rating	Exam	
S/P ACL Reconstruction Right Knee	5299-5003	20%	S/P Right Knee Anterior Cruciate Ligament Repair with Scar
	5257-5024	10%	20090223
	
Chondral Defect to Medial Femoral Condyle	Category II					
Bucket Handle Medial Meniscus Tear	Category II					
Other MEB/PEB Conditions x 0 (Not In Scope)	Other x 8 	
RATING:  20%	RATING:  10%	
*Derived from VA Rating Decision (VARD) dated 20090707 (most proximate to date of separation [DOS])  

ANALYSIS SUMMARY:  

Right Knee.  In September 2004, the CI suffered a right knee injury.  In November 2004, 2 months later, he underwent knee surgery.  In February 2005, a second surgery was done.  After the second surgery, he had physical therapy to rehabilitate the right knee.  In spite of all treatment efforts, his knee pain persisted and an MEB was initiated.  The MEB physical exam (PE) was in September 2005.  PE of the right knee revealed mild effusion, medial joint line tenderness, and varus mal-alignment.  Tests for ligamentous laxity were negative.  Range-of-motion (ROM) testing showed flexion of 120 degrees, compared to 130 degrees on the left.  Radiographic studies of the right knee showed an osteochondral defect of the medial femoral condyle.  There was no joint space narrowing, and surgical hardware was firmly in place.  The narrative summary examiner wrote: “It is the opinion of the Medical Board that the member’s condition interferes with the reasonable performance of his assigned duties.”     

The CI was medically separated from service on 6 January 2006.  In February 2009, 3 years later, he had a VA Compensation and Pension (C&P) exam. He reported pain and swelling of the right knee.  He also complained of the right knee “giving way and locking.”  Due to the right knee condition, he was not able to walk or stand for long periods.  On PE, his gait and posture were normal.  PE of the right knee revealed no edema, effusion, weakness, heat, redness, tenderness, guarding of movement, or subluxation.  There was some crepitus noted.  Tests for ligamentous laxity were negative, and ROM was full.  Right knee joint function was not additionally limited by pain, fatigue, weakness, lack of endurance, or incoordination after repetitive use.  The ROM evaluations in evidence which the Board weighed in arriving at its recommendation are summarized in the chart below.

Right Knee ROM
(Degrees)	MEB ~ 4 mos. Pre-Sep
	VA C&P ~ 3 years Post-Sep
	
Flexion (140 Normal)	120	140	
Extension (0 Normal)	5	0	

The Board directed attention to its rating recommendation based on the evidence.  The September 2005 MEB exam was much closer to the DOS, and therefore had greater probative value.  At that exam, right knee flexion was 120 degrees and extension was 5 degrees.  The Board determined that the right knee condition was essentially non-compensable, based solely on the VASRD §4.71a diagnostic codes for limitation of knee motion (5260 and 5261).  However, IAW VASRD §4.59 (painful motion) a 10% rating is warranted when there is satisfactory evidence of painful motion.  In this case, a 10% rating is also warranted under diagnostic code 5259 (cartilage, semilunar, removal of, symptomatic).  In November 2004, the CI had a partial medial meniscectomy on the right knee.  Therefore, a 10% rating was warranted based on chronic right knee pain following meniscal surgery.  The Board determined that it would be improper (pyramiding) to rate the knee using both of the coding schemes described above.  After due deliberation, the Board determined that a rating of 10% was warranted. There was no path to a higher rating, since there was no evidence of ligamentous instability, subluxation, or other seriously disabling bone or joint abnormality that would justify a higher rating.  Considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), and DoDI 6040.44 (which does not permit the Board to lower a PEB rating), the Board found insufficient cause to recommend a change in the PEB adjudication of the chronic right knee condition.  

Other PEB conditions.  The PEB adjudicated two other right knee conditions as Category II (related to the unfitting right knee condition).  These other two conditions were:  “chondral defect to his medial femoral condyle” and “bucket-handle medial meniscus tear.”  The Board determined that these two other conditions were indeed related to the unfitting right knee condition, and did not constitute separately unfitting conditions for disability rating purposes.  It was appropriate for these two conditions to be considered Category II.  After due deliberation, considering all of the evidence and mindful of VASRD §4.14 (Avoidance of pyramiding), the Board found insufficient cause to recommend a change in the PEB adjudication of the “chondral defect to his medial femoral condyle” and “bucket-handle medial meniscus tear.”    

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 unfitting right knee condition, and IAW VASRD §4.59, the Board unanimously recommends no change in the PEB adjudication.  In the matter of the “chondral defect to his medial femoral condyle” and “bucket-handle medial meniscus tear,” and IAW VASRD §4.14, the Board unanimously recommends no change in the PEB adjudication as Category II.  The Board unanimously agrees that these two right knee conditions cannot be recommended for additional disability rating.  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 20131022, 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 5 Aug 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:

- XXXXXXXXXXXXXXX, former USMC
- XXXXXXXXXXXXXXX, former USMC
- XXXXXXXXXXXXXXX, former USMC
- XXXXXXXXXXXXXXX, former USN
- XXXXXXXXXXXXXXX, former USN
- XXXXXXXXXXXXXXX, former USN
- XXXXXXXXXXXXXXX, former USMC
- XXXXXXXXXXXXXXX, former USMC
- XXXXXXXXXXXXXXX, former USMC
- XXXXXXXXXXXXXXX, former USMC