RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXXX	CASE:  PD-2014-04140
BRANCH OF SERVICE:  NAVY	SEPARATION DATE:  20040611

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E-2 (Seaman Apprentice) medically separated for left knee pain, rated 10%.

CI CONTENTION:  “Please consider all conditions.”

SCOPE OF REVIEW:  The Board’s scope of review is defined in DoDI 6040.44.  It is limited to those conditions determined by the 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 (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 

IPEB - Dated 20040401	VA* -  based on Service Treatment Records (STR)	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Left Knee Pain	5099-5003	10%	Left Knee Condition	5099-5003	0%	No Show**	
Musculoskeletal LBP	Not Unfitting/Cat III	Musculoskeletal LBP	5299-5237	0%	No Show**	
Other MEB/PEB Conditions x 0 (Not In Scope)	Other x 3 (equals SC, NSC & deferred)	
RATING:  10%	RATING:  0%	
*Derived from VA Rating Decision (VARD) dated 20050705(most proximate to date of separation (DOS)).  ** Subsequent C&P exam completed 20060105, 19 months after separation and the back was adjudicated at 10%.  The knee remained at 0%.  

ANALYSIS SUMMARY:  

Left Knee Pain Condition.  The record shows that the CI fell from a training telephone pole on 19 November 2002.  The height is recorded at various appointments as 3, 5, 15, 30, 34, and 54 feet.  There was also a history of a prior injury to the left knee in high school football.  The first record in evidence is a physical therapy (PT) note dated 27 November 2002.  His gait was painful and he began rehabilitation, but did not complete this.  X-rays on 17 March 2003 were essentially normal.  He was evaluated in orthopedics on 23 July 2003 and reported neck, back and left knee pain since the fall.  He reported subjective instability of the left knee.  On examination, there were some signs of both meniscal (a cartilage cushion for the knee) irritation and instability.  However, when examined in PT on 7 August 2003, he was thought to have a stable knee.  The narrative summary (NARSUM) was dated 9 December 2003, 6 months prior to separation, and dictated by the treating orthopedist.  It was noted that his knee had improved since he was examined in July.  Slight tenderness over the joint line was present.  The examination was otherwise normal including the range-of-motion (ROM), stability testing, and meniscal testing.  He appeared to be in no distress and no swelling was appreciated.  Painful motion was not documented.  At the medical Evaluation Board (MEB) examination on 12 January 2004, the knee was noted to be normal.  

The CI did not show for the initially scheduled VA Compensation and Pension (C&P) examination.  He was later evaluated on 5 January 2006, 18 months after separation.  At this examination, the CI reported that he did the snow blowing and was helping his father rehabilitate the house.  He jogged ½ mile twice a day, did leg presses, and could walk 4 miles.  He had applied for both construction work and farm work.  He did not use any assistive devices.  He moved freely on and off a chair and had a normal gait.  The ROM was reduced to 130 degrees in flexion, but the knee was otherwise normal.  Painful motion was not documented.  

The Board directed its attention to its rating recommendation based on the above evidence.  The PEB rated the left knee at 10%, coded 5099-5003 (analogous to degenerative arthritis).  The VA rated the left knee at 0%, coded 5099-5003 as well, and retained this rating after the VA C&P examination in 2006.  The Board found no route to a rating higher than the 10% adjudicated by the PEB.  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 left knee condition.  

Contended PEB Conditions.  The Board’s main charge is to assess the fairness of the PEB’s determination that the low back pain (LBP) was not unfitting.  The Board’s threshold for countering fitness determinations requires a preponderance of evidence, but remains adherent to the DoDI 6040.44 “fair and equitable” standard.  The CI was placed on LIMDU for the LBP (with neck and knee pain), but 10 months prior to separation.  The commander’s statement noted that the neck, back, and knee interfered with duty.  The knee and back were forwarded by the MEB.  However, there is no record of treatment for the back in the last 12 months of service.  The VA examination noted that the CI was running twice a day, lifting weights, and involved in physically demanding occupations (above).  It was reviewed and considered by the Board.  After due deliberation in consideration of the preponderance of the evidence, the Board concluded that there was insufficient cause to recommend a change in the PEB fitness determination musculoskeletal LBP condition and so no additional disability rating is recommended.  

BOARD FINDINGS:  In the matter of the left knee pain condition and IAW VASRD §4.71a, the Board unanimously recommends no change in the PEB adjudication.  In the matter of the contended LBP condition, the Board unanimously recommends no change from the PEB determination as not unfitting.  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 20140819, 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 5 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:

		- XXXXXXXXXXX, former USN
		- XXXXXXXXXXX, former USN
		- XXXXXXXXXXX, former USN
		- XXXXXXXXXXX, former USN
		- XXXXXXXXXXX, former USN
		- XXXXXXXXXXX, former USN