RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXXX	CASE:  PD-2014-02842
BRANCH OF SERVICE:  Navy 	SEPARATION DATE:  20060824

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty, E4, Storekeeper, medically separated for a “torn anterior cruciate ligament (ACL) to the right knee,” with a disability rating of 10%. 

CI CONTENTION:  “Please consider all conditions.”  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 - 20060508	VARD – 20060906	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Torn ACL to the Right Knee	5299-5003	10%	ACL Tear, Right Knee, Status Post-Surgical Intervention	5260	10%	20060417	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  10%	

ANALYSIS SUMMARY:  

Right Knee Torn Anterior Cruciate Ligament (ACL).  According to service treatment records and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI underwent right knee surgery on 16 February 2005 for a torn ACL with hamstring autograft.  In the summer of 2005 he was noted to have “marked quadriceps atrophy” and a lax ACL with a “6mm side-to-side difference on the KT-1000.”  In December 2005, he was evaluated and returned to full duty.  However despite significant improvement in his right knee condition, it could not be adequately rehabilitated to meet the physical requirements of his military specialty and the CI was referred for an MEB.  The MEB forwarded “lax ACL by KT-1000” for PEB adjudication.

The range of motion (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. 

Right Knee ROM
(Degrees)	MEB ~6 Mo. Pre-Sep	VA C&P ~4 Mo. Pre-Sep	
Flexion (140 Normal)	130	125	
Extension (0 Normal)	0	0	
Comment	Lax ACL	Painful motion and crepitus with repetitive activity	
§4.71a Rating	10%	10%	

At the MEB NARSUM examination on 16 February 2006, 6 months prior to separation, the CI reported that his pain had improved, but “still significant” and that he had “almost no instability in the knee.” He also reported that “approximately every 6 weeks or so, it will give way while active.”  The examiner recorded that the CI had “done a remarkable job” in strengthening his quadriceps and that he was able to squat over 300 pounds. The physical examination noted no quadriceps atrophy, effusion, patellar crepitus, or apprehension.  Lachman’s test showed “approximately 8 to 10 mm of translation, but has a definite firm endpoint.”  The pivot test was negative and there were no other signs of instability.  His ROM was limited as indicated in the chart above and was the same as his non-affected left knee.  There was no mention of painful motion.  

At the VA Compensation and Pension (C&P) examination in April 2006, performed 4 months before separation, the CI reported that his knee was not weak, but was stiff and gave way on occasion.  The examiner recorded that the CI’s knee did not lock or fatigue easily.  He did not have flare-ups, but used a brace to perform any form of physical activity.  Physical exam showed decreased motion.  With repetitive activity, there was pain and crepitation, but no change in the ROM due to pain, fatigue, weakness, lack of endurance or incoordination.  He had a normal gait and no objective evidence of edema, effusion, instability, weakness, tenderness, redness, heat or abnormal movement.  His ligaments were intact.  Testing for meniscal damage was negative.  
   
The Board directed attention to its rating recommendation based on the above evidence.  The PEB assigned a 10% rating under an analogous 5003 code (degenerative arthritis). The VA assigned a 10% rating using the 5260 code (leg, limitation of flexion of) based on the VA C&P examination 4 months before separation, citing painful limited motion and crepitus on repetitive motion.  There was no limitation of motion which supported a 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).  There was no history of dislocated meniscus or loose body causing frequent locking with recurrent effusions (5258), or history of surgery to remove a meniscus (5259) to support a 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 right knee condition.

BOARD FINDINGS:  In the matter of the right 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 20140612, 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 24 Jun 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 USMC
		- XXXXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXXXX, former USMC
		- XXXXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXXXX, former USMC
		- XXXXXXXXXXXXXXXXXXXX, former USMC
		- XXXXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXXXX, former USMC 

						 XXXXXXXXXXXXXXXXXXXX
	     				 	 Assistant General Counsel
						 (Manpower & Reserve Affairs)