RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2015-01092
BRANCH OF SERVICE:  Navy 	SEPARATION DATE:  20090915

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E4, Systems Organizational Initial Maintenance Technician, medically separated for “status post lateral release and with continued knee pain/patellofemoral syndrome,” with a disability rating of 10%.

CI CONTENTION:  The CI contents his rating is too low and his knee condition has caused him to be addicted to pain pills.  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 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 - 20090601	VARD - 20100407	
Condition	Code	Rating	Condition	Code	Rating	Exam	
S/P Lateral Release…Knee Pain…	5099-5003	10%	Right Knee Condition	5256	NSC	STR	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  --	

ANALYSIS SUMMARY:  

Status Post Lateral Release with Continued Knee Pain/Patellofemoral Syndrome.  According to service treatment records (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s underwent an arthroscopic lateral release for right knee pain with decreased range of motion on 27 May 2008.  Post-operatively the right knee range of motion improved.  The CI was able to walk without pain, was unable to run.  Ultram (opioid pain medication) was used for pain management, but had limited coverage of the pain.  Physical limitations included climbing stairs, deep knee bends, crawling, kneeling, and carrying heavy loads.  Despite treatment, the right knee condition could not be adequately rehabilitated to meet the physical requirements of the CI’s military specialty and the CI was referred for MEB.  The MEB forwarded “pain in joint involving lower leg” for PEB adjudication.  The MEB NARSUM examination on 3 January 2009, 8 months prior to separation, noted complaints of persistent right knee pain with difficulty completing military tasks, climbing stairs, deep knee bends, crouching, crawling, kneeling, running, and squatting.  The CI reported being able to walk only 15 minutes without pain before having to stop.  The right knee examination showed normal strength and range of motion.  Patella laxity with pain laterally and increased right knee mobility relative to the left was noted.  Meniscal and ligamentous testing were negative.  The CI had a negative McMurray test (evaluates tears in meniscus), negative pivot shift (anterior cruciate ligament test), and negative Lachman (anterior cruciate ligament stability test).  Neurological examination was intact.  At the MEB examination (recorded on DD Forms 2807 and 2808) dated March 2009, 6 months prior to separation, the CI reported right knee swelling after 10-15 minutes of walking.  A knee brace was reported as “used often” to support and stabilize.  Physical examination showed full range of motion, some pain with medial joint line, 4/5 strength, negative McMurray/Lachman, negative posterior drawer (cruciate ligament test).  CI was able to squat but, had pain with standing.  At the Orthopedic examination dated 15 April 2009, 5 months prior to separation, the physical examination showed full range of motion as flexion to 140 degrees (normal 140), extension to 0 degrees (normal 0), normal gait, and normal reflexes.  Sensation was intact.  There was no VA Compensation and Pension (C&P) evaluation performed proximate to separation.  

The Board directed attention to its rating recommendation based on the above evidence.  The PEB rated the right knee condition 10%, coded 5099-5003 (analogous to arthritis, degenerative).  The VA found the right knee condition not service connected” (NSC) coded 5256 (knee, ankyloses).  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.  In considering support for a higher rating, the Board noted the presence of completely stable ligaments.  The Board concluded there was insufficient evidence of ligament instability to support dual coding under 5003 and 5257.  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 20150609, 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 25 Apr 17

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

						  XXXXXXXXXXXXXXXXXX
	     				  	  Assistant General Counsel
						  (Manpower & Reserve Affairs)