RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX		CASE:  PD-2014-04217
BRANCH OF SERVICE:  NAVY		SEPARATION DATE:  20040613

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E5, Builder, medically separated for “right knee pain,” with a disability rating of 10%.

CI CONTENTION:  VA service connected conditions directly affect daily quality of life and ability to maintain employment.  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 - Dated 20040325	VARD - 20041102	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Right Knee Pain	5299-5003	10%	Right Knee, Postoperative Residuals of ACL Reconstruction	5259-5260	20%	20040816	
Chronic Anterior Knee Pain	Cat II					
Status Post Two Arthroscopic Debridements	Cat II					
COMBINED RATING:  10%	COMBINED RATING FOR ALL VA CONDITIONS:  50%	

ANALYSIS SUMMARY:

Right Knee Pain.  According to service treatment record (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI underwent three right knee surgeries in May 2002, October 2002 and August 2003.  Despite post-operative physical therapy, the right knee condition could not be adequately rehabilitated to meet the physical requirements of the CI’s military specialty and he was referred for a MEB.  The MEB forwarded “right knee pain status post arthroscopic debridement x2 and anterior cruciate ligament (ACL) reconstruction” for PEB adjudication.

The MEB NARSUM dated 17 November 2003 (7 months before separation), noted CI reports of anterior right knee pain aggravated by running and squatting.  Physical examination (PE) revealed full range of motion (ROM) and mild crepitus.  Provocative tests for instability were negative.

At the VA Compensation and Pension (C&P) examination in August 2004 (2 months after separation), the CI reported right knee pain and wearing a hinge brace for 2 years.  The examination revealed decreased right knee flexion of 120 degrees (normal 140) with marked crepitus.  There was no effusion.  Provocative tests for instability were negative.  At a VA primary care visit in April 2005, 10 months after separation, the CI reported chronic right knee pain.  The examination revealed normal ROM with crepitus.

The Board directed attention to its rating recommendation based on the above evidence.  The PEB rated the condition 10% analogously coded 5299-5003 (degenerative arthritis) with application of the VASRD.  The VA rated the condition 20% coded 5259-5260 (cartilage, removal of, symptomatic-limitation of flexion) based on the C&P examination 2 months after separation, citing limitation of motion with additional weakness.  Board members agreed there was no limitation of flexion or extension that supported a minimum rating under the VASRD diagnostic codes for limitation of motion (5260 or 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 evidence of subluxation or lateral instability to support a separate 10% rating under the 5257 code (knee, other impairment).  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).  Though there was evidence of meniscus surgery (5259) the Board concluded the pain symptom was already a component of the painful ROM noted above and if applied again would be considered pyramiding IAW §4.14 (avoidance of pyramiding).  After due deliberation, and considering all 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 pain 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 following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20141031, 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 10 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:

		- XXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXX, former USMC
		- XXXXXXXXXXXXXXXXXX, former USMC
		- XXXXXXXXXXXXXXXXXX, former USMC
		- XXXXXXXXXXXXXXXXXX, former USMC
		- XXXXXXXXXXXXXXXXXX, former USMC
		- XXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXX, former USMC