RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2015-00927
BRANCH OF SERVICE:  Navy 	SEPARATION DATE:  20030314

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E5, Refrigeration and Air Conditioning Systems Technician, medically separated for “degenerative arthritis, right knee,” with a disability rating of 20%.

CI CONTENTION:  The CI did not submit a contention in the application.  The CI’s complete submission is 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 - 20021121	VARD - 20030602	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Degenerative Arthritis, Right Knee	5099-5003	20%	Post-traumatic Degenerative Joint Disease, Right Knee, Status Post Partial Meniscectomy	5010-5260	10%	20030120	
COMBINED RATING:  20%	COMBINED RATING OF ALL VA CONDITIONS:  40%	

ANALYSIS SUMMARY:  

Degenerative Arthritis, Right Knee.  According to service treatment record and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s right knee condition began in when she was “18 or 19 years old” while playing basketball.  According to the reported history she had an arthroscopy and may have had a partial meniscectomy.  The CI had little issues with her right knee for several years until she re-injured it again while playing basketball in May 2000.  Radiographic studies revealed moderate degenerative arthritis about the right knee.  Orthopedic evaluation also revealed degenerative arthritis of the right knee with likely meniscal tear.  On 22 November 2000, she underwent a partial meniscectomy and debridement of the right kneecap.  Despite extensive physical therapy, chondral injections, and prolonged physical restrictions, she could not be adequately rehabilitated to meet the physical requirements of her military specialty and the CI was referred for an MEB.  The MEB forwarded “degenerative arthritis, right knee” for PEB adjudication.  At the MEB NARSUM examination, performed 7 months prior to separation, the CI reported complaints of bilateral knee pain (right greater than left).  She reported pain with running, squatting, kneeling or any other type of strenuous activity.  The MEB physical examination (PE) revealed tenderness, mild effusion, and crepitus about the right knee.  She maintained a normal gait and near normal range of motion (ROM) of the right knee; flexion of 135 degrees (normal 140 degrees), and extension was not documented.  Instability tests were negative and there was normal strength and sensation of the right lower extremity.  

At the 20 January 2003 VA Compensation and Pension (C&P) evaluation, performed 2 months prior to separation, the CI reported continued right knee pain.  During the PE, the examiner stated “The ROM reveals flexion pain at 40 degrees and extension with pain from 5 degrees to 0 degrees without ability for full extension due to pain.”  The examiner also noted that there was no further limitation by fatigue, weakness, lack of endurance or incoordination.  The examiner was not able to perform clinical joint stability testing due to the CI’s discomfort.  

The Board directed attention to its rating recommendation based on the above evidence.  The PEB rated the right knee condition at 20%, analogously coded as 5099-5003 (degenerative arthritis).  The VA rated the right knee condition at 10%, dual coded as 5010-5260 (traumatic arthritis/leg, limitation of flexion), citing painful and limited motion.  There was no limitation of motion which supported a 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.  The examinations proximate to separation did not demonstrate the presence of ligamentous instability or laxity (5257), and there was no history of dislocated meniscus or loose body causing frequent locking with recurrent effusions (5258) to support a rating under the respective codes.  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 was no VASRD §4.71a route to a rating higher than the 20% adjudicated by the PEB under any applicable code, and no grounds for additional ratings.

BOARD FINDINGS:  In the matter of the right knee degenerative arthritis 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 20150605, 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 13 Dec 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 USN 
		- XXXXXXXXXXXXXXXXXX, former USN 
		- XXXXXXXXXXXXXXXXXX, former USN 
		- XXXXXXXXXXXXXXXXXX, former USN 
		- XXXXXXXXXXXXXXXXXX, former USN 
		- XXXXXXXXXXXXXXXXXX, former USN 
		- XXXXXXXXXXXXXXXXXX, former USMC 
		- XXXXXXXXXXXXXXXXXX, former USN 
		- XXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXX, former USN 

						            XXXXXXXXXXXXXXXXXX	     				  					Assistant General Counsel
	(Manpower & Reserve Affairs)