RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2015-02033
BRANCH OF SERVICE:  Navy 	SEPARATION DATE:  20030412

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E3, Aviation Boatswain’s Mate, medically separated for “persistent left anterior knee pain status post lateral release,” with a disability rating of 10%.   

CI CONTENTION:  “Review all conditions.”  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 - 20021021	VARD - 20030523	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Persistent Left Anterior Knee Pain…	5299-5003	10%	Left Knee Torn Lateral Meniscus Repair	5259	10%	20030321	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  40%	

ANALYSIS SUMMARY:  

Persistent Left Anterior Knee Pain Status Post Lateral Release.  According to the service treatment record (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s condition began in August 2001 after stepping in a hole and twisting her left knee while running, albeit she had chronic bilateral knee pain prior to enlistment.  Because of persistent pain and swelling of the knee and a positive McMurray’s test (to determine a meniscal tear), the CI underwent left knee arthroscopic lateral release surgery on 30 November 2001.  Approximately 8 weeks postoperatively at a physical therapy evaluation, the CI stated she slipped off the stairs where she twisted her knee.  She experienced pain in swelling in the knee.  At an appointment on 21 February 2002, the CI complained of ongoing knee pain.  Physical examination showed the CI walked with a normal gait, exhibited minimal edema and was tender to palpation.  Range of motion (ROM) measurements were 0-110 degrees (normal 140).  Magnetic resonance imaging (MRI) on 2 April 2002, showed a possible horizontal tear involving both the anterior and posterior horns of the lateral meniscus on one cut only.  An 18 April 2002 orthopedic clinic appointment it was noted that the CI’s knee continued to improve following surgery and she only complained of aching with hyper-flexion.  The examiner noted the CI had full ROM with minimal retropatellar tenderness.  Additionally, the examiner noted the MRI finding of a lateral meniscus tear was unlikely.    

The 25 June 2002 MEB NARSUM, 10 months prior to separation, noted complaints of pain with flexion, squatting or kneeling, and the inability to run.  Her knee did not lock or catch, but she did experience occasional giving way sensation with pain.  Physical examination revealed the CI had full ROM with normal patellar tracking, patellar tilt and no effusion.  The knee was stable without any laxity or evidence of a meniscal tear (negative McMurray’s test), but the CI did experience tenderness around the patella.  The CI sustained an injury to the left knee when an 800 pound metal sprocket (an arresting gear component) slid on to the left leg/knee on 11 October 2002, which caused abrasions from the femur to the medial aspect of the lower leg, and X-rays showed a normal left knee.  Treatment consisted cleaning the abrasions, a knee immobilizer, crutches, and Tylenol #3 (codeine, a narcotic, and acetaminophen, a pain reliever), which was replaced by Motrin (ibuprofen, a nonsteroidal anti-inflammatory drug (NSAID)) 5 days later.  At an orthopedic evaluation on 18 October 2002, ecchymoses (black and blue marks) were present in the injury area consistent with a contusion, and the knee was stable. 

At the 21 March 2003 VA Compensation and Pension (C&P) evaluation, 1 month before separation, the CI experienced dull pain with swelling during exacerbations.  Physical examination showed the CI walked with a normal gait and showed no instability.  Knee ROM measurements were flexion 120 degrees and extension 0 degrees with no lateral motion.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the left knee condition 10%, coded 5299-5003 (arthritis, degenerative).  The VA also rated the left knee condition 10%, coded 5259 (cartilage, semilunar, removal of, symptomatic), based on the C&P examination 1 month before separation, citing removal of semilunar cartilage.  
There was no limitation of motion which supported a rating under the diagnostic codes for limitation of flexion or extension (5260, 5261) or evidence of painful motion with functional loss supporting a 10% rating (based on VASRD §4.59, §4.40 and §4.45). There was no history or evidence of dislocated meniscus or loose body causing frequent locking with recurrent effusions (5258), to support a rating under that code.  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).  Therefore, there was 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 panel concluded that there was insufficient cause to recommend a change in the PEB adjudication for the left knee condition.  

BOARD FINDINGS:  In the matter of the persistent left anterior knee pain status post lateral release condition and IAW VASRD §4.71a, the panel unanimously recommends no change in the PEB adjudication.  There are no other conditions within the panel’s scope of review for consideration.  The panel, therefore, recommends that there be 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 20150610, 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:

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

	
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	     				  Acting