RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXXX	CASE:  PD-2014-03130
BRANCH OF SERVICE:  Navy 	SEPARATION DATE:  20091110

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E5, Logistics Specialist, medically separated for “right knee tri-compartment osteoarthritis s/p fractured femur,” with a disability rating of 10%.

CI CONTENTION:  The CI listed his unfitting right knee and multiple other VA identified conditions not considered.  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 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 - 20090729	VARD - 20100223	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Right Knee Tri-Compartment Osteoarthritis Status Post Fractured Femur	5099-5003	10%	Right Knee Degenerative Joint Disease	5003	10%	20091029	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  80%	

ANALYSIS SUMMARY:  

Right Knee Tri-Compartment Osteoarthritis Status Post Fractured Femur.  According to service treatment records (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI sustained a right distal femoral fracture at age 15, which reportedly involved the growth plate.  He underwent an open reduction and internal fixation (ORIF) surgical procedure which was complicated by a postoperative right knee infection.  The wound was debrided and recovery resulted in a leg length discrepancy requiring a heel lift.  The healed femoral fracture required a waiver prior to entering the Navy.  The CI’s right knee pain progressed throughout his Naval career.  There were no other traumatic events which precipitated his right knee pain.  Radiographic (X-ray) studies completed on 16 May 2009 showed moderate to severe tri-compartmental degenerative changes.  At the 3 June 2008 sports medicine appointment, the CI reported chronic knee pain, worse over the last month (since being assigned to an aircraft carrier).  On examination there was full range of motion (ROM) without effusion (fluid collection), well healed surgical scars, and joint line tenderness medially, laterally, and at the patellofemoral joint.  There was no ligamentous instability or laxity and signs of meniscus problems were absent.  There was no surgical indication, and conservative treatment including two periods of limited duty (LIMDU) and Hyalgan (intraarticular viscoelastic joint [synovial] fluid supplement) injections did not result in improvement sufficient to allow unrestricted duty. 

Despite treatment, the right knee condition could not be adequately rehabilitated to meet the physical requirements of the CI’s military specialty and the CI was referred for an MEB.  The MEB forwarded “osteoarthrosis, unspecified whether generalized or localized, lower leg” for PEB adjudication.  At the 11 June 2009 MEB NARSUM examination, the CI reported a significant increase in his right knee pain after being assigned to a carrier.  The MEB physical examination noted full ROM without effusion.  There was joint line tenderness medially, laterally, and along the patellofemoral joint.  Dynamic tests for ligamentous instability and meniscus pathology were negative.  At the 29 October 2009 VA Compensation and Pension (C&P) examination, 12 days before separation, the CI reported right knee pain from walking up and down shipboard ladders and decks.  The CI reported symptoms of weakness, swelling, and pain, lack of endurance, dislocation, tenderness, and effusion with flares twice a week making it difficult to stand for prolonged periods or walking.  Flares were reported to last 1 or 2 days with a pain level of 6/10 and relieved by rest and Mobic.  Functional impairments included difficulty with stairs, running, kneeling, and squatting.  Physical exam showed a normal gait and posture.  The bilateral knee exam revealed crepitus (grating sensation or sound), but no ankylosis (joint stiffening or immobility).  Collateral and cruciate ligament and meniscal examinations were normal.  Right knee ROM was flexion of 130 (140 normal) and extension of 0 (0) degrees with pain occurring at 130 degrees of flexion.  There was pain with ROM, but no change with repetition.  Strength, sensation, and deep tendon reflexes (DTRs) were normal.

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 also assigned a 10% rating using the 5003 code based on the VA C&P examination 12 days before separation, citing limited and painful motion of a major joint.  The proximate examinations did not demonstrate a limitation of motion to support a minimum rating under limitation of flexion (5260) or extension (5261).  While the CI underwent an ORIF for a distal femur fracture, there was no femur nonunion/malunion (5255) for consideration under the respective code.  There was no knee ankylosis (5256), knee recurrent subluxation/lateral instability (5257), dislocated meniscus (5258), symptomatic removed meniscus (5259), tibia and fibula nonunion/malunion (5262), or genu recurvatum (5263) for consideration under the respective codes.  The Board agreed there was evidence of painful motion with functional loss supporting a 10% rating (based on §4.40, §4.45, and §4.59).  There was therefore no VASRD §4.71 a 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 20140628, 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 31 May 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)