RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXXX	CASE:  PD-2014-03637
BRANCH OF SERVICE:  Navy	SEPARATION DATE:  20070615

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E6, Law Enforcement Specialist, medically separated for “right knee osteoarthritis” with a disability rating of 20%.

CI CONTENTION:  “See attached VA Rating Decision.”  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 based on 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 – 20070507	VARD - 20071024	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Right Knee Osteoarthritis	5262	20%	Osteoarthritis, Right Knee, Status Post-Surgical Reconstruction	5010	10%	20070829	
COMBINED RATING:  20%	COMBINED RATING OF ALL VA CONDITIONS:  60%	

ANALYSIS SUMMARY:

Right Knee Osteoarthritis.  According to service treatment records (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI was status post patellar tendon repair and anterior cruciate ligament reconstruction surgery (which occurred prior to accession).  The CI’s enlistment physical cleared him for full duty.  Subsequently, over the CI’s 14-year career, his right knee became chronically painful with multiple additional surgeries, with the most proximate to separation occurring in July 2003 for debridement of a complex lateral meniscal tear.  Following this last surgery, further treatment did not result in improvement sufficient to allow unrestricted duty.  The MEB forwarded “osteoarthrosis, localized, primary, involving lower leg” for PEB adjudication.  At the 15 February 2007 MEB NARSUM examination, 4 months before separation, the CI reported diffuse pain in his right knee with no instability.  Pain level was 0/10 when his right knee was at rest.  The CI experienced some sensation of “catching” and his right knee swelled with activity.  He was unable to run secondary to pain.  The physical examination documented a normal gait, a well healed anterior surgical scar, and moderate lateral knee and joint line tenderness.  There was no patella tenderness or effusion (fluid collection).  Range of motion (ROM) showed flexion to 125 (normal 140) with extension lacking 5 (0) degrees.  There was pain with full flexion, moderate crepitance (grating sensation or sound) with flexion and extension, and a negative patellar grind (assess abnormal patellar movement and painful crepitation) test.  There was pain with the McMurray (assess menisci) test and no ligamentous instability.  The lower leg showed normal strength and no pain with resisted leg extension.

At the 29 August 2007 VA Compensation and Pension (C&P) examination, 2 months after separation, the CI reported right knee pain with stiffness which made it difficult to stand more than a few minutes.  The CI said he could walk more than ¼ mile, but less than 1 mile.  There were no reports of instability, giving way, weakness, locking, effusion, dislocation or subluxation.  The CI reported weekly flare ups of pain described as severe in nature which lasted hours.  Physical examination showed no evidence of abnormal weight bearing (normal gait).  There was no right lower extremity scar, deformity, quadriceps atrophy, tenderness, or effusion.  Pain limited ROM was flexion to 100 and extension to 0 degrees.  There was palpable crepitus noted and a positive McMurray’s test with apprehension and pain.  All tests for instability were negative.  There was no additional limitation after repetitive motion testing, other than pain as noted.  An X-ray showed postsurgical changes, moderate arthritis, and intracapsular bony (ossific) bodies.

The Board directed attention to its rating recommendation based on the above evidence.  The PEB assigned a 20% rating coded 5262 code (tibia and fibula, impairment of, with moderate knee or ankle disability).  The VA assigned a 10% rating coded 5010 (arthritis due to trauma) based on the VA C&P examination 2 months after separation, citing “painful or limited motion of a major joint that is arthritic.”  There was no evidence of marked knee disability to support a 30% rating under the 5262 code (tibia and fibula, impairment of).  There was no limitation of flexion (5260) or extension (5261) to support a rating under the respective codes.  There was no evidence of ligamentous instability or laxity to support a rating under the 5257 code.  While the CI underwent a lateral meniscal tear debridement, there was no dislocated meniscus (5258) or symptomatic removed meniscus (5259) to support a rating at separation.  The Board did not recommend disability rating for scars unless their presence imposes a direct functional limitation that renders the CI unfit.  The CI’s right knee scar did not interfere with wear of military gear and was not painful at the MEB NARSUM examination.  There was insufficient evidence of duty-limiting impairment from the knee scar, thus the Board concluded that the scar condition could not be recommended for additional disability 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 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 20140123, 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 21 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 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, former USN
		- XXXXXXXXXXXXXXXXXXXX, former USN

						  	XXXXXXXXXXXXXXXXXXXX
	     				  		Assistant General Counsel
						  	(Manpower & Reserve Affairs)