RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2014-02314
BRANCH OF SERVICE:  NAVY  	
DATE OF PLACEMENT ONTO TDRL:  20050816
DATE OF REMOVAL FROM TDRL:  20080418

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E-6, NATO Sea Sparrow Surface Missile System Technician, medically separated from the Temporary Disability Retired List (TDRL) for “status post anterior cruciate ligament revision with chondrosis of the patellofemoral articulation,” with a disability rating of 10%.

CI CONTENTION:  The CI asserts that the Veterans Administration (VA) refused a total knee replacement.  He also contends the diagnosis differed from one Medical Evaluation Board to the other and laxity diagnosed in both VA examinations was not mentioned in the PEB results.  The CI’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 Military 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 – 20050427/20080115	VARD - 20050812	
Condition	Code	Rating	Condition	Code	Rating
Proximate	
		TDRL
Placement	TDRL Removal			TDRL
Placement	TDRL
Removal	
Leg, Limitation Of Extension	5261	30%	10%	Right Knee Laxity…	5257	20%	20%	
Persistent Right Knee Pain	Cat II	Right Knee Traumatic Arthritis	5010-5020	10%	10%	
Status Post Anterior Cruciate Ligament Revision with Chondrosis of the 
Patellofemoral Articulation	Cat II					
Medial Femoral Condyle	Cat II					
Status Post Anterior Horn Medial and Lateral Meniscal Tears	Cat II					
COMBINED RATING: 30% → 10%	COMBINED RATING OF ALL VA CONDITIONS:  30%	

ANALYSIS SUMMARY:  

Leg, Limitation of Extension.  

According to service treatment records (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s underwent right knee surgery (right anterior cruciate ligament revision and meniscal debridement) in April 2004 for right knee swelling, pain, and limitation of motion.  At the time of the surgery significant cartilage damage was noted at the end of the femur and patella.  The MEB NARSUM examination on 22 March 2005 (5 months prior to TDRL placement) noted complaints of right knee swelling, pain on ambulation, difficulty extending the knee fully.  He denied giving wat or locking.  Physical examination showed right knee discomfort and tightness with squatting, an inability to fully extend, decreased sensation at the outer aspect, a significantly restricted mobility of the patella in comparison to the left.  Instability testing was negative and there is no tenderness on palpation of the knee or the surgical wounds.  At the VA Compensation and Pension (C&P) examination in May 2005, performed 3 months before TDRL placement, the CI reported marked pain with ambulation and swelling with physical activities (swimming and elliptical machine).  Physical examination showed a mild right lower extremity limp, numbness at the outer front aspect of the knee, and pain and weakness during motion.  There was tenderness over the anterior tibia, crepitus (grinding sensation with motion), and medial, anterior and rotational instability.  There was significant weakness of the right quadriceps muscle.  Radiographic evaluation in May 2007 showed significant post-traumatic severe osteoarthritis predominantly at the patellofemoral and medial aspects of the right knee.  The MEB NARSUM examination on 7 August 2007 (5 months prior to TDRL removal) noted complaints of difficulty with weight bearing activities, an inability to run, swelling with activities, and some catching anteriorly. He denied instability.  Physical examination showed an antalgic gait, healed surgical scars, tenderness to palpation, and decreased patella mobility.  Laxity testing was negative except for trace medial with valgus stress.  Meniscal testing was negative.  There was no swelling.

The Board directed its attention to its rating recommendation based on the above evidence.  At TDRL placement the PEB rated the right knee (status post anterior cruciate ligament revision with chondrosis of the patellofemoral articulation) condition 30% (coded 5256, [severe knee, other impairment of]) and adjudicated the status post anterior horn medial and lateral meniscal tears, medial femoral condyle, and persistent right knee pain conditions as Category II (related to the unfitting condition).  The VA dual rated the right knee laxity condition 20% (coded 5257, [knee, other impairment of])], citing moderate laxity and right knee arthritis at 10% (coded 5010-5260 [arthritis due to trauma-leg limitation of flexion]) citing instability, limited motion, pain on motion with flexion, lack of endurance, and marked restricted motion after repetitive use.  The examinations proximate to TDRL placement demonstrated the presence of ligamentous instability or laxity (5257), painful motion (5003), and functional loss (4.40).  The Board considered dual coding of the knee for painful motion and instability; however, there was no VASRD §4.71a route to a rating higher than 30% adjudicated by the PEB under any applicable code at TDRL placement.  At TDRL removal the PEB adjudicated the right knee condition as, leg limitation of extension at 10%, (coded 5261).  The examination proximate to TDRL removal supported a 10% rating under 5261 for limitation of leg extension to 10 degrees adjudicated by the PEB.  The examinations did not demonstrate  limitation of extension to 15 degrees (5260) limitation of flexion to 30 degrees (5260), the presence of ligamentous instability or laxity (5257), or 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 was 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 right knee conditions at TDRL placement and removal.  

BOARD FINDINGS:  In the matter of the right condition (status post anterior cruciate ligament revision with chondrosis of the patellofemoral articulation, status post anterior horn medial and lateral meniscal tears, medial femoral condyle, and persistent right knee pain) and IAW VASRD §4.71a, the Board unanimously recommends no change in the PEB TDRL placement and removal adjudications.  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 20140514, 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 Sep 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:

		- XXXXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXXXX, former USN
		- 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)