RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2015-01348
BRANCH OF SERVICE:  Navy 	SEPARATION DATE:  20031201

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E3, Surface Sonar Technician, medically separated for “right knee pain” rated at 10%.

CI CONTENTION:  His knee condition continues to worsen and negatively impact daily activities and quality of life.  The CI’s 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 panel 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 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 panel 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 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 - 20031016	VARD - 20040910	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Right Knee Pain…	5299-5003	10%	Residuals of Torn Medial Meniscus with Patellar Tendonitis, Right Knee	5260	0%	STR	
Right Knee Patellofemoral Syndrome	Cat II					
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  0%	

ANALYSIS SUMMARY:  

Right Knee Pain.  According to service treatment records (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI underwent right knee surgery in 1997 for a right medial meniscus tear (MMT).  He recovered well and was cleared by orthopedics for accession.  He did well until he slipped during a fire drill in December 2002 and reinjured his right knee.  He was thought to have a recurrent MMT.  This was repaired surgically on 25 March 2003.  He was noted to have degeneration consistent with the initial injury.  Despite rehabilitation in physical therapy, he was not able to return to full duty and referred for an MEB.  The MEB forwarded “right knee pain s/p partial medial meniscectomy” for PEB adjudication. In physical therapy on 31 July 2003, 4 months prior to separation, the CI was noted to have normal motion and an essentially normal gait.  Extension was painful.  The MEB NARSUM was dated 14 August 2003, 3 months prior to separation.  He reported ongoing pain with activity.  On examination, the ROM was full.  No comment was made regarding painful motion.  The knee was stable.  Tenderness was noted about the patellar (kneecap) tendon.  The pain was thought to be secondary to the meniscal repair and patellofemoral syndrome (PFS).  No comment was made on the gait.  The CI did not report for the initial VA Compensation and Pension (C&P) examination, but was evaluated on 7 June 2005, 18 months after separation and outside the normal 12-month window assigned higher probative value.  He noted ongoing pain, but no assistive device was in use.  The ROM was reduced in flexion to 130 degrees (VA normal is 140).  No comment was made on painful motion.  The knee stable.  Crepitus, an audible or sensible grating sensation, was present.  An X-ray was noted to be “neg” (normal).  The scars were well healed.  

The Board directed attention to its rating recommendation based on the above evidence.  The PEB rated the Category I right knee pain 10%, coded 5299-5003 (analogous to degenerative arthritis).  The PEB also listed right knee patellofemoral syndrome as a related Category II condition (a condition that contributed to the primary unfitting condition but was not separately ratable).  The impairment from the right knee patellofemoral syndrome was properly subsumed under the overall rating for the right knee pain condition IAW §4.14 (avoidance of pyramiding; more than one rating based on the same impairment is prohibited).  The VA rated the right knee 0%, coded 5260 (leg, limitation of flexion of), citing limitation of motion, based on STR, but subsequently raised it to 10% based on the above C&P.  The limitation of motion is non-compensable and the knee was stable.  The CI was symptomatic from the MMT and surgery supporting a 10% rating under the code 5259 (symptomatic removal of a meniscus).  This provided no advantage to the CI though.  The Board found no route to a rating higher than the 10% adjudicated by the PEB under any applicable code, and no grounds for additional rating based on the presence of instability.  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 pain.  

BOARD FINDINGS:  In the matter of the right knee pain 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 20150615, 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