RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2015-00682
BRANCH OF SERVICE:  navy	SEPARATION DATE:  20030326

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

CI CONTENTION:  “My knee still swells, pops, and locks.  It is all I can do some days to fight through the pain to do my job.”  The complete submission is at Exhibit A.  

SCOPE OF REVIEW:  The panel’s scope of review is defined in DoDI 6040.44.  It is limited to review of disability ratings assigned 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 or non-compensable.  Any conditions outside the panel’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 panel’s authority is limited to assessing the fairness and accuracy of PEB rating determinations and recommending corrections, where appropriate.  The panel’s assessment of the PEB rating determination 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 panel has neither the role nor the authority to compensate for progression or complications of service-connected conditions after separation.  That role and authority is granted by Congress to the Department of Veterans Affairs, operating under a different set of laws.  The panel 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 - 20030304	VARD - NA	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Left Knee Pain	5299-5003	10%	No VA Examination in Evidence 	
Left Knee Meniscal Tear 	CAT II		
Left Knee Anterior Cruciate Ligament Tear			
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  NA	

ANALYSIS SUMMARY:   

Left Knee Pain.  According to the service treatment record and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI underwent left knee surgery on 25 September 2001 for anterior cruciate ligament (ACL) reconstruction with a hamstring graft and a partial medial meniscectomy to repair a medial meniscus tear.  On 15 January 2002 the CI had 3-4 mm laxity on the left versus 1-2 mm on the right.  Although the CI’s knee felt stable on 29 August 2002, he was unable to traverse ladders.    

At the time of the orthopedic clinic appointment on 30 December 2002, 5 months prior to separation, the CI endorsed soreness after hard work. The examiner noted a full range of motion (ROM), no effusion or tenderness to palpation (TTP), but Lachman’s and pivot tests were positive (determinants of instability).  The examiner did not think the CI could handle shipboard duty.  

The 3 January 2003 MEB NARSUM examination, 4 months prior to separation, noted two prior periods of limited duty (LIMDU) for the left knee diagnoses.  Physical examination showed full ROM with no significant effusion.  The examiner noted there was no TTP, but the CI had a positive Lachman test (test for instability) and a slight pivot shift.  The knee was neurovascularly intact distally.  Radiographic (X-ray) studies showed good position of the tunnels from the ACL reconstruction.  Conservative treatment after surgery did not improve the CI’s condition enough for him to return to previous activity levels.  He denied instability, but complained of pain while running.  The examiner noted the CI could not perform his duties especially aboard ship which included “ladder climbing, stair climbing and deck work.”  

A 24 June 2003 follow-up physical therapy note indicated the CI wore an ACL brace.  The CI endorsed pain relief for up to 4 hours, increased endurance/stability, improved flexibility/mobility and an increase in activities from conservative treatment.  He had improved ROM with flexion of 115 degrees (normal 140) and extension of 3 degrees (normal 0) and 4+/5 strength.  He had a normal gait, no TTP and good balance during a single leg squat testing.  The therapist stated the CI had improved significantly and had been compliant with treatment.  There was no VA examination in evidence proximate to separation

The panel directed attention to its rating recommendation based on the above evidence. The PEB rated the left knee pain condition 10%, analogously coded 5003 (arthritis, degenerative), citing painful motion and the inability to perform his duties aboard ship.  There was no evidence of moderate knee disability to support a 20% rating under code 5255 (femur, impairment of) or code 5262 (tibia and fibula, impairment of).  There was no limitation of motion  using code 5260 (leg, limitation of flexion) or code 5261 (leg, limitation of extension), or evidence of dislocated meniscus or loose body causing frequent locking with recurrent effusions (code 5258) to support a rating under those respective codes.  Code 5279 (cartilage, semilunar, removal of, symptomatic) is applicable; however, the maximum 10% rating under that code provides no additional benefit to the CI.  

The panel agreed that the left knee medial meniscus tear and left knee anterior cruciate ligament tear conditions determined to be Category II conditions (conditions which contributed to the primary unfitting condition but were not separately ratable) were intertwined diagnoses with the Category I diagnosis, and the overall knee impairment from all listed diagnoses was subsumed under the ratings for the knee by the PEB.  More than one rating based on the same impairment is prohibited, IAW §4.14 (avoidance of pyramiding).  After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the panel concluded that there was insufficient cause to recommend a change in the PEB adjudication for the left knee pain condition.  

BOARD FINDINGS:  In the matter of the left knee pain condition and IAW VASRD §4.71a, the panel unanimously recommends no change in the PEB adjudication.  There are no other conditions within the panel’s scope of review for consideration.  The panel, therefore, recommends that there be no modification or re-characterization of the CI’s disability and separation determination. 

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20160603, w/attachments
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment 

MEMORANDUM FOR DIRECTOR, SECRETARY OF THE NAVY COUNCIL OF REVIEW BOARDS

Subj: PHYSICIU. DISABILITY BOARD OF REVIEW (PDBR) RECOMMENDAT IONS Ref:	(a) DoDI 6040.44
In accordance with reference (a), I have reviewed the cases listed below and 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 USN
	XXXXXXXXXXXXXXXXXX, former USN
	XXXXXXXXXXXXXXXXXX, former USN
	XXXXXXXXXXXXXXXXXX, former USN
	XXXXXXXXXXXXXXXXXX, former USN
	XXXXXXXXXXXXXXXXXX, former USMC
	XXXXXXXXXXXXXXXXXX, former USN