RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXXX	CASE:  PD-2014-00648
BRANCH OF SERVICE:  NAVY	SEPARATION DATE:  20071030

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E-5 (Aviation Support Equipment Technician Second Class) medically separated for left knee condition.  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 (LIMDU) and referred for a Medical Evaluation Board (MEB).  Osteoarthrosis, unspecified whether general or localized, unspecified site and old disruption of anterior cruciate ligament [ACL] were forwarded to the Physical Evaluation Board (PEB) IAW SECNAVINST 1850.4E.  No other condition was submitted by the MEB.  The Informal PEB (IPEB) adjudicated post-traumatic arthritis, left knee valgus as unfitting, rated 10% with application of the Veteran’s Affairs Schedule for Rating Disabilities (VASRD).  The remaining ACL insufficiency condition was determined to be Category II (contributing to unfit condition).  The CI made no appeals and was medically separated.

CI CONTENTION:  “Low back pain and 40%.”  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 condition outside the Board’s defined scope of review (such as the additional back condition cited in the contention) and any contention not requested in this application may remain eligible for future consideration by the Board for Correction of 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:

Service IPEB – Dated 20070705	VA* - (~6 Mos. Post-Separation)	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Post-Traumatic Arthritis, Left Knee Valgus	5257	10%	DJD, Left Knee	5010-5260	0%	20080503	
ACL Insufficiency	Category II					
Other MEB/PEB Conditions x 0 (Not In Scope)	Other x 9	
Combined:  10	Combined:  20%	
*Derived from VA Rating Decision (VARD) dated 20080528 (most proximate to date of separation [DOS])

ANALYSIS SUMMARY:

Post-Traumatic Arthritis, Left Knee Valgus (Cat II ACL Insufficiency).  The record shows that the CI had left knee surgery in 1991, 5 years prior to accession.  This was declared and the CI cleared for enlistment.  He initially did well, but subsequently had left knee pain which impaired full duty and he was placed on LIMDU for multiple periods, the final 6-month period to expire on 27 June 2007.  He continued to have pain and was referred for MEB for separation consideration on 30 May 2007.  At the MEB Narrative Summary (NARSUM) Examination dated 30 May 2007, approximately 5 months before separation, the CI reported longstanding left knee pain dated to before service.  It was thought that he had repair of a torn lateral meniscus (internal knee cartilage cushion towards the outside) and the anterior cruciate ligament (ACL) which provides stability for the knee.  On examination, the range-of-motion (ROM) was slightly reduced, but painful motion was not documented.  The knee was stable except for one test for the ACL which was Grade I-II (normal is Grade I), but with a firm endpoint.  This is consistent with a prior repair with good results.  At the DD Form 2808, Report of Medical Examination, dated, approximately 5 months before separation, the CI reported bilateral knee arthritis.  He was noted to be tender to palpation bilaterally on examination.

At the VA Compensation and Pension (C&P) examination dated 3 May 2008, 6 months after separation, the CI reported the history of left knee surgery in 1993 (the accession history noted 1991; this had no impact on the adjudication) after twisting it playing basketball.  He reported pain at rest, but denied instability.  On examination, his gait was normal and muscle atrophy absent.  Signs of meniscal irritation were not present and the ROM was near normal as recorded below.  Painful motion was not present.  X-rays showed degenerative changes (not unexpected after surgery).

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.

Left Knee ROM
(Degrees)	NARSUM (LIMDU)
~10 Mo. Pre-Sep	NARSUM (MEB)
~5 Mo. Pre-Sep	VA C&P
~6 Mo. Post-Sep	
Flexion (140 Normal)	120	110	130	
Extension (0 Normal)	0	0	0	
Comment	Effusion	Grade I-II Lachman with firm endpoint; Off Loader Brace	Stable knee; pain free motion	
§4.71a Rating	0%	0%	0%	

The Board directed attention to its rating recommendation based on the above evidence.  The PEB rated the left knee at 10%, coded 5257 (Other impairment of the knee), for slight instability.  The VA rated the knee at 0%, coded 5010-5260 (Traumatic arthritis – limitation of flexion).  The Board considered the evidence.  The ROM is not compensable and painful motion is not clearly recorded prior to separation and specifically excluded at the VA examination.  One test for stability was borderline abnormal, but within the expected range after surgery.  The Board found no route to a rating higher than the 10% adjudicated by the PEB.  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 re-characterization of the CI’s disability and separation determination.

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20140109, 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 22 Dec 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 USN
- XXXXXXXXXXXXXXXXXXXX former USN 
- XXXXXXXXXXXXXXXXXXXX former USN

						  XXXXXXXXXXXXXXXXXXXX
	     				  Assistant General Counsel
						  (Manpower & Reserve Affairs)