RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXXXX	CASE:  PD-2015-01182
BRANCH OF SERVICE:  Navy 	SEPARATION DATE:  20050815

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E4, Fire Control Technician, medically separated for “right knee traumatic arthrosis,” with a disability rating of 10%.

CI CONTENTION:  “Numerous issues with knee.  Have serious issues walking and now my other knee is starting to have severe pain.” 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 - 20050505	VARD – NA	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Right Knee Traumatic Arthrosis	5299-5003	10%	No VA Claim in Evidence	
Right Knee Pain	Category II		
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  NA	

ANALYSIS SUMMARY:  

Right Knee Traumatic Arthrosis.  According to service treatment records (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI sustained a complete rupture of the right anterior cruciate ligament (ACL) and medial meniscus tear in 2001 that were surgically repaired.  The CI did well until October 2003 when a heavy container was lowered on to his knee at a recycling center injuring the knee again.  He had increasing right knee pain that was not responsive to physical therapy and underwent a diagnostic knee arthroscopy that found an intact ACL graft, normal posterior cruciate ligament, arthritic changes of the articular cartilage and further tearing of the medial meniscus.  After additional physical therapy with lack of improvement the CI was offered a high tibial osteotomy due to the varus alignment (bow legged) and progressive pain in the medial compartment of his knee (which was performed on 29 July 2004).  Following surgery further treatment did not result in improvement sufficient to allow unrestricted duty.  The MEB forwarded “pain in joint, lower leg” for PEB adjudication.  The MEB NARSUM examination on 28 January 2005, 5 months post-surgery and 8 months prior to separation, noted the CI’s right knee pain was moderate.  Physical examination recorded significant crepitus with only slight movement.  No other examination findings were recorded.  At the MEB examination (recorded on DD Forms 2807 and 2808) dated February 2005, 6 months post-surgery and 7 months prior to separation, the CI reported it was painful to walk.  The examiner noted the CI’s inability to weight bear on his right leg.

The MEB NARSUM addendum dated 11 April 2005, 4 months prior to separation, noted the CI’s complaints of pain going up and down stairs and walking on uneven terrain. The pain was primarily in the medial aspect of the knees, but occasionally pain occurred on the lateral aspect.   Pain was absent when the CI walked on flat surfaces.  The CI complained of pain and crepitus with range of motion (ROM) activities and climate changes.  He also reported that he was not able to run or climb ladders.  Physical examination demonstrated painful motion and crepitus.  ROM testing showed flexion was 120 degrees (normal is 140) and extension to -5 degrees (5 degrees of hyperextension, normal is 0).  All tests for instability were negative.  There was tenderness to palpation along the joint line and the CI experienced pain during the McMurray’s (test for torn meniscus) on the medial side of the knee.  Plain film X-rays revealed medial patellofemoral compartment degenerative changes.  The family practice examination on 25 April 2005 noted the CI had twisted his knee several days prior.  The CI had an antalgic gait.  Further physical examination showed tenderness at the lateral and medial joint line and effusion.  The CI’s ligaments were intact (no instability).  
There was no VA Rating Decision or examination in evidence.   

The Board directed attention to its rating recommendation based on the above evidence.  The PEB rated the right knee traumatic arthrosis condition 10%, analogously coded 5299-5003 (arthritis, degenerative).  The PEB also listed “right knee pain” as a related Category II condition (a condition that contributed to the primary unfitting condition but was not separately ratable).  The Board agreed that the impairment from the right knee pain was properly subsumed under the overall rating for the right knee traumatic arthrosis condition IAW §4.14 (avoidance of pyramiding; more than one rating based on the same impairment is prohibited).  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 supporting a 10% rating (based on §4.59) as adjudicated by the PEB.  There was no history of dislocated meniscus or loose body causing frequent locking with recurrent effusions to support a rating under codes 5258.  The 5259 code (cartilage, semilunar, removal of, symptomatic) was applicable in this case but the maximum 10% rating under that code provided no rating benefit to the CI.  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 therefore no VASRD §4.71a route to a rating higher than the 10% adjudicated by the PEB under any applicable code.  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 traumatic arthrosis condition.    

BOARD FINDINGS:  In the matter of the right knee traumatic arthrosis 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

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 26 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:

		- XXXXXXXXXXXXXXXXXXXXX, former USMC
		- XXXXXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXXXXX, former USMC
		- XXXXXXXXXXXXXXXXXXXXX, former USMC
		- XXXXXXXXXXXXXXXXXXXXX, former USMC
		- XXXXXXXXXXXXXXXXXXXXX, former USMC
		- XXXXXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXXXXX, former USMC
		- XXXXXXXXXXXXXXXXXXXXX, former USN 
		- XXXXXXXXXXXXXXXXXXXXX, former USN 
		- XXXXXXXXXXXXXXXXXXXXX, former USMC 
		- XXXXXXXXXXXXXXXXXXXXX, former USMC
		- XXXXXXXXXXXXXXXXXXXXX, former USMC
		- XXXXXXXXXXXXXXXXXXXXX, former USMC
		- XXXXXXXXXXXXXXXXXXXXX, former USMC
		- XXXXXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXXXXX, former USMC