RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXXX	CASE:  PD-2014-00943
BRANCH OF SERVICE:  Navy 	SEPARATION DATE:  20080206

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was a Naval Reserve, E5, Aircraft Mechanic, medically separated for “chronic left knee pain” and contributing “left knee patellofemoral pain syndrome”; with a disability rating of 10%.  

CI CONTENTION:  His left knee condition continues to worsen and affect his daily life.  The applicant’s complete submission is at Exhibit A.  

SCOPE OF REVIEW:  The Board’s scope of review is defined in DoDI 6040.44.  It is limited to those conditions determined by the Physical Evaluation Board (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 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 Veterans Affairs Schedule for Rating Disabilities (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 PEB - 20070425	VARD - 20070813	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Left Knee Pain	5299-5003	10%	Status Post Partial Meniscectomy Left Knee 	5257	10%	20070709	
Left Knee Patellofemoral Pain Syndrome	Category II					
RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  20%	

ANALYSIS SUMMARY:  

Chronic Left Knee Pain, Status Post Left Knee Arthroscopy, with Partial Medial Meniscectomy.  According to service treatment records (STR) and the MEB narrative summary (NARSUM), the CI underwent left knee surgery in December 2006, for a partial medial meniscectomy.  X-ray images in January 2006 showed no evidence for fracture or other significant bone or soft tissue abnormality.  At the VA Compensation and Pension (C&P) examination on 25 January 2005, performed 3 months after REFRAD and 36 months before separation, the CI reported burning, aching and sharp 10/10 knee pain.  The physical exam showed signs of edema.  The medial and lateral collateral ligament stability test showed no instability.  The medial and lateral meniscus test showed no snapping or clicking.  The range of-motion (ROM) was flexion 140 degrees (140 degrees normal) and extension 0 degrees (0 degrees normal).  At the time of the physical therapy clinic appointment on 15 May 2006, the CI reported pain 10/10 at worst with moderate catching and locking.  The physical examination showed an antalgic gait, tenderness to palpitation, painful flexion of 100 degrees (140 normal), and 3/5 muscle strength limited by pain and/or guarding.  Despite treatment, the CI’s knee condition could not be adequately rehabilitated to meet the physical requirements of the CI’s military specialty and was referred for a Medical Evaluation Board (MEB).  At the MEB examination (recorded on DD Forms 2807 and 2808) dated 29 August 2006, 19 months after REFRAD and 18 months before separation, the CI reported he was still having pain in his left knee when going up and down stairs.  The physical examination showed popping of the left knee.  At the time of the MEB NARSUM dated 23 January 2007, performed 12 months before separation, the CI reported intermittent swelling  and chronic knee pain with prolonged sitting, standing and negotiating stairs..  The MEB physical examination noted the CI had a normal gait.  There was no effusion or medial or lateral joint line tenderness.  Tests for anterior and posterior cruciate ligament integrity; lateral and medial collateral ligaments; and meniscal damage were negative.  He had pain on the medial aspect of the left knee with squats and positive patellar grind and quadriceps inhibition.  His range-of-motion (ROM) was 125 degrees of flexion (140 degrees normal and 0 degrees extension (0 degrees normal).  At the VA Compensation and Pension (C&P) examination on 9 July 2007, performed 8 months before separation, the examiner recorded left knee weakness, lack of endurance, and giving way with activity such a walking and running.  The CI reported localized 8/10 pain, occurring 3-4 times per day, and lasting for 2 hours.  The CI denied stiffness, locking, fatigue, and dislocation.  On examination the left knee was tender to palpation, guarding with movement, and “locking pain.”  There was no edema, effusion, weakness, abnormal movement, subluxation, or crepitus.  The ROM was flexion to 120 degrees (140 degrees normal) and 0 degrees of extension (0 degrees normal).  On repetition the joint function was additionally limited by pain, fatigue, weakness, and lack of endurance.  

The Board directed attention to its rating recommendation based on the above evidence.  The PEB rated the chronic left knee pain; status post left knee arthroscopy, with partial medial meniscectomy condition 10%, coded 5299-5003(analogous arthritis, degenerative).  The Navy PEB included left knee patellofemoral pain syndrome as a related Category II condition subsumed under the Category I, chronic left knee pain, status post left knee arthroscopy, with partial medial meniscectomy condition.  There was no VA rating for the left knee condition, based on the 25 January 2006 C&P examination.  The VA rated the left knee condition 10% coded 5257, (Knee, other impairment of), citing slight subluxation or lateral instability based on the 9 July 2007 C&P examination.  There was no limitation of motion which attained a minimum rating under the diagnostic codes for limitation of flexion or extension (5260, 5261). However, there was evidence of painful motion with functional loss supporting a 10% rating (based on §4.59, §4.40 and §4.45) as adjudicated by the PEB.  The examinations proximate to separation did not demonstrate the presence of ligamentous instability or laxity (5257), frequent locking with effusions or any indication of dislocated meniscus or loose body (5258), or history of surgery to remove a meniscus (5259) to support a higher rating under the respective codes.  There was no fracture, non-union, or malunion of the femur or tibia to support consideration under the respective codes for knee impairment related to long bone conditions (5255, 5262).  There is therefore no VASRD §4.71a route to a rating higher than the 10% adjudicated by the PEB under any applicable code, and no grounds for additional rating based on the presence of instability.  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:  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.  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 20140223, with attachments
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 11 Mar 16

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