RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXXX	CASE:  PD-2014-03680
BRANCH OF SERVICE:  Navy 	SEPARATION DATE:  20031016

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty, E1, Seaman Recruit, medically separated for “right knee medial collateral ligament sprain,” with a disability rating of 10%.  

CI CONTENTION:  The CI requests the board 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 - 20030804	VARD – 20031124	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Right Knee MCL Sprain	5024-5003	10%	Right Knee MCL Strain	5257	10%	STR	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  10%	

ANALYSIS SUMMARY:  

Right Knee Medial Collateral Ligament (MCL) Sprain.  According to service treatment records and the medical evaluation board (MEB) narrative summary (NARSUM), the CI’s right knee condition began in April 2003 after twisting her knee while marching.  Diagnostic imaging showed MCL thickening.  There was no surgical indication.  Despite treatment, the CI’s right knee condition could not be adequately rehabilitated to meet the physical requirements of the CI’s military specialty and was referred for a MEB.  

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 ~3 Mo. Pre-Sep	Ortho ~3  Mo. Pre-Sep	VA C&P ~10 Mo. Post-Sep	
Flexion (140 Normal)	130	“FROM”	130	
Extension (0 Normal)	0		0	
Comment	Painful motion; tenderness; no instability	Tenderness	Painful motion; slight instability	
§4.71a Rating	10%	0%	10% + 10% (VA 10%)	

At the MEB examination (recorded on DD Form 2807 and 2808) dated 3 July 2005, 3 months prior to separation, the CI reported that her right knee locked up on a regular basis, had given out on her three times, and had been painful since her injury.  Physical exam showed pain with flexion, extension, and weight bearing.  At the MEB NARSUM exam, dated 9 July 2003, 3 months prior to separation, the CI reported that her right knee is painful and is made worse with any prolonged activity.  The examiner noted that she was unable to run for greater than half a mile or walk or stand for prolonged periods of time without leg pain.  On examination of the right knee, there was tenderness and limitation of motion as indicated in the chart above, but no swelling, effusion, ligamentous instability or laxity and signs of meniscus problems were absent.  There was increased pain with Valgus stress.  At the orthopedic clinic appointment on 28 July 2003, 3 months before separation, the examination showed tenderness to palpation at the MCL and tibial tubercle, but no swelling or ligamentous instability.  The CI had full active ROM as indicated in the chart above.  

At the VA Compensation and Pension (C&P) examination on 4 August 2004, performed 10 months after separation, the CI reported continued pain in the right knee and swelling with activity, but that the knee did not give way.  She walked a half mile three times a week.  She tried to work as a paramedic in a hospital emergency room, but developed pain and swelling in the knee and had to quit.  She could not walk very far, run, had trouble going down stairs, could not lift over 30 pounds, had to sit with her legs extended, and had trouble driving a car with a standard shift.  Physical exam showed a slight decrease in flexion with painful motion as indicated in the chart above with a 5 degree loss due to pain.  She had minimal tenderness, slight crepitus, slight laxity with valgus compression, a negative Lachman’s test, and slight instability of the right knee.  

The Board directed attention to its rating recommendation based on the above evidence.  The PEB rated the right knee condition 10%, coded 5024-5003 (tenosynovitis).  The VA originally rated the right knee condition 10%, coded 5257, (knee, other impairment of: recurrent subluxation or lateral instability), citing “slight medial collateral ligament disability in right knee that includes medial right knee pain when the knee is stressed.”  The VARD dated September 2004 added a 10% rating for the knee coded 5010-5260 (traumatic arthritis causing leg limitation of flexion) citing painful motion in addition to the 10% 5257 rating for instability (dual rating).  There was no limitation of motion which attained a minimum 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) as adjudicated by the PEB.  Although the VA exam conducted 10 months after separation showed slight instability of the right knee, the examinations most proximate to separation vigorously tested for but did not demonstrate the presence of any ligamentous instability or laxity to support a 10% or higher rating under code 5257. 
 
There was no evidence of dislocated meniscus or loose body to support a rating under code 5258.  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 (dual rating) based on the presence of instability at the time of separation.  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 20140730, with attachments
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)