RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXX	CASE:  PD-2014-01882
BRANCH OF SERVICE:  NAVY	BOARD DATE:  2014926
Separation Date:  20030519

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty P03/E-4 (HM3/General Duty Corpsman) 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) status and referred for a Medical Evaluation Board (MEB).  The right knee condition, characterized by the MEB as “tricompartmental chondromalacia of the right knee,” “lateral meniscus tear” and “left knee neuroma” (Board believes this to be an error and should have been right knee), were forwarded to the Physical Evaluation Board (PEB) IAW SECNAVINST 1850.4E.  The Informal PEB adjudicated “tricompartmental chondromalacia of the right knee” as unfitting, rated at 10%, with likely application of the Veterans Affairs Schedule for Rating Disabilities (VASRD).  The remaining conditions, right knee neuroma and lateral meniscus tear, surgically treated were determined to be Category II conditions.  The CI made no appeals and was medically separated.

CI CONTENTION:  “Back, neuropathy, knees, migraines, reproductive organ, depression, left shoulder, corn, congestive heart failure, decreased hearing were listed.”

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 right knee condition is addressed below; and, no additional conditions are within the DoDI 6040.44 defined purview of the Board.  The contended back, neuropathy, migraines, reproductive organ, depression, left shoulder, corn, congestive heart failure and decreased hearing conditions were not identified by the MEB or PEB, and thus are 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.  IAW DoDI 6040.44, the Board’s authority is limited to making recommendations on correcting disability determinations.  The Board’s role is thus confined to the review of medical records and all evidence at hand to assess the fairness of PEB rating determinations, compared to VASRD standards, based on ratable severity at the time of separation.

RATING COMPARISON:

Service IPEB – Dated 20030212	VA - (21 Mos. Post-Separation) 	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Tricompartmental Chondromalacia, Rt. Knee	5299-5003	10%	Status Post (s/p) Repair, Lateral Meniscal Tear with Osteoarthritis, Rt. Knee	5260	10%	20050216	
Lateral Meniscus Tear, Surgically Treated	Category II					
Rt. Knee Neuroma, Surgically Treated	Category II	No VA Entry	
No Additional MEB/PEB Conditions	Other x9	
Rating:  10%	Combined:  50%	
Derived from VA Rating Decision (VARD) dated 20050426 (most proximate to date of separation) 

ANALYSIS SUMMARY:  The PEB adjudicated the lateral meniscus tear, surgically treated and right knee neuroma surgically treated conditions as Category II conditions.  These conditions will be discussed below under the unfitting condition.

Tricompartmental Chondromalacia, Right Knee Condition.  There were three goniometric range-of-motion (ROM) evaluations in evidence, with documentation of additional ratable criteria, which the Board weighed in arriving at its rating recommendation; as summarized in the chart below:

Right Knee ROM(Degrees)	MEB ~ 4.5 Mo. Pre-Sep	Ortho ~ 4.5 Mo. Pre-Sep	VA C&P ~ 1.5yrs. Post-Sep	
Flexion (140 Normal)	120	100	115	
Extension (0 Normal)	0	0	0	
Comment	Pos. antalgic gait & joint line tenderness; Stable ligaments; Pos. pain with patellar grind	Tenderness to palpation (TTP) below lateral joint line	Normal gait; Pos. painful motion & effusion; No instability; No Deluca criteria	
§4.71a Rating	10%	10%	10%	

The CI injured his right knee in December 2000 when he slipped from a step aboard ship and hyperextended his knee.  He was seen in primary care for persistent anterior-lateral joint line pain and stiffness.  There were physical exam findings of a small effusion, tenderness of the medial joint line and a positive Apley’s test (meniscal tear on the medial side).  The right knee magnetic resonance imaging (MRI) showed a bucket handle tear of the lateral meniscus and a probable fibroma of the distal femur.  The orthopedist noted that an effusion, positive Apley’s and tenderness along the lateral joint line.  The CI continued to follow by PT for strengthening exercises.  He was placed on 30 day LIMDU status on 11 June 2001 thru 11 July 2001, for his right knee meniscal tear condition.  The orthopedist noted TTP to the lateral joint line, a positive McMurray’s sign lateral meniscus tear and ROM limited to 120 degrees with pain.  On 30 April 2002 the CI underwent an arthroscopy, chondroplasty and partial lateral meniscectomy of the right knee.  He resumed PT however he continued to have antalgic gait, pain and constant swelling and the use of crutches for ambulation.  

The CI was placed on a second LIMDU status on 2 May 2002 (for 8 months), post-operative procedure.  The MRI of the right knee obtained in August 2002, showed new transverse tears of the lateral meniscus.  The orthopedist noted a loss of flexion motion of 15 degrees to 20 degrees, TTP anterior lateral and medial menisci and knee popping with maneuvers.  The CI underwent a second arthroscopy with a removal of a small neuroma in October 2002.  

The MEB narrative summary (NARSUM) exam (approximately 4 months prior to separation), noted constant right knee pain despite having two arthroscopic surgeries.  The Board makes note that on the NARSUM under diagnoses the phrase “left knee” was penciled out and right knee was written in.  The orthopedist provider noted that the CI had chronic pain with flexion.  The physical exam findings are summarized in the chart above.  The CI was scheduled for a series of right-knee steroid injections which were started in February 2003.  The MEB NARSUM physical examination findings are summarized in the chart above.  

The non-medical assessment noted that the CI had to take frequent breaks and was incapable of prolonged standing or moderate walking and required use of a cane for short walks.  The condition interfered with the performance of his MOS duties and therefore the CI consider non-deployable.  

The VA Compensation and Pension (C&P) exam (approximately a year after separation), documented that the CI required a cane because his knee was “swollen, locked and had constant pain all day, every day.”  He reported an inability to kneel, run, walk fast, squat, crawl or run upstairs.  He was also unable to sit for any significant length of time during a flare in cold weather.  The VA C&P physical exam findings are summarized in the chart above.

The Board directed attention to its rating recommendation based on the above evidence.  The PEB coded the tricompartmental chondromalacia, right knee condition as code 5299 analogous to 5003 (arthritis, degenerative hypertrophic or osteoarthritis) and rated at 10%.  The VA coded the status post repair lateral meniscal tear with osteoarthritis of the right knee as code 5260 (limitation of leg flexion) and rated at 10% (flexion limited to 45 degrees).  All exams performed proximate to separation documented pain-limited motion.  No exam indicated instability, current meniscal injury, or limited ROM to a compensable level without application of §4.59 (painful motion).  VASRD §4.71a specifies for use of code 5003, satisfactory evidence of painful motion and specifies a 10% rating for each major joint or group of minor joints affected by limitation of motion.  The Board considered coding the right knee condition using codes 5259 and 5260; however, these coding schemes would not result in a higher 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 tricompartmental chondromalacia, right 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 tricompartmental chondromalacia, right knee condition and IAW VASRD §4.71a, the Board unanimously recommends no change in the PEB adjudication.  In the matter of the lateral meniscus tear, surgically treated and right knee neuroma surgically treated contended conditions; the Board unanimously recommends no change from the PEB determinations as not unfitting.  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 20140415, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans’ Affairs Treatment Record

XXXXXXXXXXXXXX
President
Physical Disability Board of Review

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 8 Apr 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:

- XXXXXXXXXXXXXX, former USN
- XXXXXXXXXXXXXX, former USMC
- XXXXXXXXXXXXXX, former USN
- XXXXXXXXXXXXXX, former USN
- XXXXXXXXXXXXXX, former USN
- XXXXXXXXXXXXXX, former USMC
- XXXXXXXXXXXXXX, former USN
- XXXXXXXXXXXXXX, former USMC
- XXXXXXXXXXXXXX, former USMC 
- XXXXXXXXXXXXXX, former USN
- XXXXXXXXXXXXXX, former USN
- XXXXXXXXXXXXXX, former USMC
- XXXXXXXXXXXXXX, former USN
- XXXXXXXXXXXXXX, former USN

						  XXXXXXXXXXXXXX
	     				  Assistant General Counsel
						  (Manpower & Reserve Affairs)