RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2015-01414
BRANCH OF SERVICE:  Navy 	SEPARATION DATE:  20050201

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E7, Nuclear Plant Supervisor, medically separated for “full thickness condylar lesion of the medial femoral condyle and trochlear” and “left knee pain” as a Category II condition (contributes to the unfitting condition), with a combined disability rating of 20%.  

CI CONTENTION:  “Review all conditions.”  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 - 20041108	NO VA CLAIM	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Condylar Lesion (Left Knee) ...	5099-5003	20%	No VA Examination in Evidence	
Knee Pain	Category II		
COMBINED RATING:  20%	COMBINED RATING OF ALL VA CONDITIONS:  N/A	

ANALYSIS SUMMARY:  

Left Knee Condition (Subsuming Category II).  According to service treatment records (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI suffered a left knee injury in a 2002 motorcycle accident (tibial contusion, meniscal tear, no fractures).  Failing conservative management, he underwent an initial surgery in November 2003 (arthroscopic meniscal repair and chondroplasty for full thickness lesion of the medial femoral condyle); and, a repeat surgery (arthroscopic debridement, revision, microfracture) in June 2004 (8 months before separation).  There was intraoperative confirmation of intact ligaments, as well clinical confirmation of stability to stress testing in all planes in STR clinical entries.  There was likewise STR clinical confirmation of negative signs of impingement (locking), with no evidence to the contrary, and there was no documentation of persistent effusions.  There were two separate orthopedic entries after the last surgery which documented the same range of motion (ROM): flexion to 135 degrees (normal 140, 45 for minimum 10%) and extension of 0 degrees (normal). There was no STR documentation (after surgical recovery) of any more significant (or minimum compensable) ROM limitation.  No additional surgery was recommended; further conservative treatment did not result in sufficient improvement to allow unrestricted duty; and, the CI was referred for a MEB.  The MEB forwarded “condylar lesion of the medial femoral condyle and trochlear” and “knee pain” for PEB adjudication.  

The MEB NARSUM examination on 25 August 2004, 6 months before separation, documented “continues to have pain and difficulty with steps ... unable to run.”  The physical examination recorded tenderness and “minimal effusion” with no mention of instability or impingement.  The measured ROM was flexion to 135 degrees and extension to 0 degrees.  

There was no VA claim, evaluation, or treatment; and, there was no other post-separation evidence in this case.  

The Board directed attention to its rating recommendation based on the above evidence.  Members first agreed that the Category II condition of knee pain was intrinsic to the unfitting rated condition and not subject to additional rating without violation of VASRD §4.14 (avoidance of pyramiding).  The PEB rated the left knee condition 20% analogously coded 5099-5003 (degenerative arthritis).  There was no minimum compensable ROM limitation, evidence for persistent effusion and locking, or fracture with non-union or malunion to support a rating higher than 10% under any applicable code; and, there was no evidence of joint instability for separate rating.  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 of the left knee condition.  

BOARD FINDINGS:  In the matter of the left 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 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

						  XXXXXXXXXXXXXXXXXX
	     				  	  Assistant General Counsel
						  (Manpower & Reserve Affairs)