RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXX	CASE:  PD-2015-01976
BRANCH OF SERVICE:  navy	SEPARATION DATE:  20041115

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E6, Senior Enlisted Damage Control Program Management and Training Specialist, medically separated for “status post anterior cruciate ligament reconstruction right knee” with a disability rating of 20%.

CI CONTENTION:  The CI contends that her left knee should have also been rated by the service.  The 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 Board 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 determination 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(s) 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 - 20041004	VARD - 20050225	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Right Knee Pain	5099-5003	20%	Residuals, Right Anterior Cruciate Ligament Reconstruction	5260	10%	20061010	
Status Post ACL Reconstruction, Right Knee	Category II					
Arthrofibrosis	Category II					
COMBINED RATING:  20%	COMBINED RATING OF ALL VA CONDITIONS:  50%	

ANALYSIS SUMMARY:

Right Knee.  According to the service treatment record (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI underwent right knee arthroscopic surgery in October 2003 for anterior cruciate ligament (ACL) and partial medial tears.  She underwent a subsequent diagnostic arthroscopic surgery in May 2004 and had the hardware removed.  She also underwent manipulation under anesthesia, which brought her up to near full extension.  The CI was followed by physical therapy and orthopedics from May 2004 to September 2004.  Range of motion (ROM) studies during that period showed that right knee flexion measurements ranged from 100 to 120 degrees (normal 140) while extension measurements ranged from 0 to 7 degrees (normal 0).  

The 13 September 2004 MEB NARSUM examination, 2 months prior to separation, noted complaints of right knee pain and mechanical symptoms.  Physical examination showed a right knee flexion contracture of 60 degrees (inability to fully extend the leg due to a bone fragment or other tissue getting in the way and blocking movement), but she could flex her right knee to 120 degrees.  She had some pain any time stress was placed on her knee to try to get beyond the above mentioned limits of flexion and extension and there was pain with passive ROM testing.  She had no medial joint line tenderness or lateral joint line tenderness, but did have some symptoms with patellar compression.  Provocative tests to detect ligamentous instability were negative.  

At the 17 November 2004 VA Compensation and Pension (C&P) evaluation, less than 1 month after separation, the CI reported right knee pain with weather changes, discomfort with knee extension, and popping along the medial aspect with prolonged use.  Physical examination showed crepitus and knee flexion was 120 degrees and extension was 0 degrees without painful motion to include repetitive ROM.  Stability and meniscal testing were not addressed.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the right knee condition 20%, analogously coded 5099-5003 (degenerative arthritis).  The PEB also listed right knee status post ACL reconstruction, and arthrofibrosis as related Category II conditions (conditions that contributed to the primary unfitting condition but were not separately ratable).  The VA rated the right knee condition 10%, coded 5260, based on the C&P examination less than 1 month after separation, citing crepitus, limitation of flexion to 120 degrees, and X-ray findings of postoperative knee changes.  

The panel considered the flexion contracture noted in the NARSUM, but dismissed it as a factor for rating based on the historical ROM studies in the STR and the post-separation C&P examination, none of which showed this pathology.  The panel noted that there was no limitation of motion to support a rating under the codes for limitation of flexion or extension (5260, 5261).  There was no fracture, nonunion or malunion of the femur or tibia to support consideration under the respective codes for knee impairment related to long bone conditions (5255, 5262).  After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the panel 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 chronic right knee condition and IAW VASRD §4.71a, the panel unanimously recommends no change in the PEB adjudication.  There were no other conditions within the panel’s scope of review for consideration.  The panel, therefore, recommends no modification or 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

      In accordance with reference (a), I have reviewed the cases listed below and 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:

		- XXXXXXXXXXXXXXXXXXX, former USMC
		- XXXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXXX, former USMC
		- XXXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXXX, former USMC
		- XXXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXXX, former USMC
		- XXXXXXXXXXXXXXXXXXX, former USN

		
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	     				  Acting