RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2015-02439
BRANCH OF SERVICE:  Navy 	SEPARATION DATE:  20050502

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E6, Refrigeration and Air Conditioning Systems Technician, medically separated for “right knee pain” 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 - 20041208	VARD - 20051109	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Lateral Meniscal Tear Right Knee	5099-5003	10%	Degenerative Joint Disease, Right Knee	5010-5260	10%	20050413	
Osteochondral Defects of Medial Femoral Condyle, Right Knee	Cat II					
Patellofemoral Syndrome, Right Knee	Cat II					
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS: 30%	

ANALYSIS SUMMARY:  

Right Knee Pain.  According to the service treatment record (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI underwent surgical debridement of his right knee in late 2000 to debride a large osteochrondral defect (joint cartilage damage).  He reinjured his right knee in August 2004.  Radiographic studies revealed a torn right lateral meniscus and degenerative changes in the medial meniscus.  The CI declined surgery.  

The 7 October 2004 MEB NARSUM examination, 12 months prior to separation, noted complaints of significant difficulty with shipboard activities, persistent right knee swelling, and catching with intermittent locking.  He endorsed the inability to run and or jump and reported no history of knee instability.  His physical examination (PE) revealed an antalgic gait.  The single direction range of motion (ROM) of flexion was painful and near normal at 130 degrees (normal = 140).  Tenderness, grinding, crepitus, and effusion were present about the right knee.  Stability maneuvers were performed normally without deficits.     

At the 13 April 2005 VA Compensation and Pension (C&P) evaluation, performed 6 month before separation, the CI reported pain in both knees increasing with squatting as well as climbing ladders.  His PE revealed no synovial thickening, no warmth, no effusion, no tenderness, no ligamentous laxity, or bony hypertrophy.  Knee appearance and flexion ROM was normal. 

The Board directed attention to its rating recommendation based on the above evidence.  The PEB rated the right knee condition at 10%, analogously coded 5099-5003 (degenerative arthritis).  The VA rated the same knee at 10% dual coded 5010-5260 (traumatic arthritis causing limitation of flexion in the leg), based on the VA C&P examination 6 months prior to separation, citing painful motion.  

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 with functional loss supporting a 10% rating (based on §4.59, §4.40 and §4.45) as adjudicated by the PEB. The examinations proximate to separation did not demonstrate the presence of ligamentous instability or laxity (5257), and there was no history of dislocated meniscus or loose body causing frequent locking with recurrent effusions (5258), or history of surgery to remove a meniscus (5259) to support a rating under the respective codes. 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).  No additional functional limitation was evidenced by the examinations.  There is therefore no VASRD §4.71a route to a rating higher than the 10% adjudicated by the PEB under any applicable VASRD 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 condition. 

Other PEB Conditions.  Osteochondral defect of the medial femoral condyle, right knee, and patellofemoral syndrome, right knee, were adjudicated by the PEB as related category II conditions (conditions that contributed to the primary unfitting condition but were not separately ratable).  The Board unanimously agreed that these diagnostic conditions were related and included in the discussion above and therefore do not warrant consideration as separately unfitting conditions.  All related symptoms and or functional impairments were subsumed under the rating for the primary right knee condition as noted above.

BOARD FINDINGS:  In the matter of the right 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 modification or re-characterization of the CI’s disability and separation determination.  

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20151010, 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 USN
		- XXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXX, former USMC
		- XXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXX, former USN

		
							  XXXXXXXXXXXXXXXXXX
	     				  Acting