RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXX 	CASE:  PD-2016-00004
BRANCH OF SERVICE:  navy 	SEPARATION DATE:  20050610

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was a Navy Reserve E5, Aviation Boatswain’s Mate, Fuel Specialist Second Class, medically separated for “right knee osteoarthritis and medial meniscus tear” with a disability rating of 10%.  

CI CONTENTION:  The CI contends bilateral patella chondromalacia, bilateral ankle arthritis and low back pain.  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 - 20050415	VARD - 20061116	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Right Knee OA and MMT	5299-5003	10%	DJD Right Knee	5010-5260	10%	20060830	
Bilateral Patella Chondromalacia	Cat II	DJD Left Knee	5010-5260	10%	20060830	
Bilateral Ankle Arthritis	Cat III	No VA Exam in Evidence	
Low Back Pain	Cat III	Lumbago	5299-5237	NSC	20060830	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  40%	

ANALYSIS SUMMARY:  	

Right Knee Osteoarthritis (OA) and Medial Meniscus Tear (MMT).  According to the service treatment record (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s bilateral knee condition began in May 2003 after he felt a pop in the right knee during physical training.  The CI underwent arthroscopic meniscal debridement of his right knee in July 2003. Then in December 2003, he underwent arthroscopic debridement on his left knee.  The CI reported very minimal relief from the procedures.  

The 4 November 2004 MEB NARSUM examination, 6 months prior to separation, noted complaints of bilateral anterior knee pain and pain with activity.  The physical examination of the bilateral knees showed no effusion or tenderness to palpation.  The CI complained of pain with patella compression as well as medial and lateral translation of the patella.  The ROM showed flexion of 125 degrees (140 normal) and extension of 0 degrees (normal), bilaterally.  The knees were stable and signs of meniscal irritation were absent.  The CI was diagnosed with chondromalacia patella of the bilateral knees.  During the November 2004 MEB examination (recorded on DD Forms 2807-1 and 2808), 5 months prior to separation, the CI reported bilateral knee pain with complaints of numbness below the knees after sitting longer than 30-40  minutes and daily swelling.  The CI reported he uses knee braces and sometimes crutches when the knees were swollen.  The 74 inch CI was noted to weigh 288 pounds, up from 263 pounds in April 2003 prior to his injury.  

At the 30 August 2006 VA Compensation and Pension (C&P) evaluation, 16 months after separation, the CI reported constant pain and the inability to walk long distances, stiffness and swelling.  He also reported falling several times due to his knees giving way.  The physical examination noted his gait was within normal limits.  The CI now weighed 306 pounds.  The knees showed no signs of edema, effusion, weakness, tenderness, redness heat, abnormal movement or guarding of movement.  There was crepitus bilaterally.  The gait was normal and no assistive device was in use.  Flexion of the right knee was 90 degrees (140 normal) and painful with normal extension.  The left was 100 degrees flexion and painful with normal extension.  The CI was noted to have slight instability bilaterally of the anterior and posterior cruciate ligaments as well as the medial and lateral collateral ligaments.  The CI was also noted to have signs of meniscal irritation for both the medial and lateral menisci bilaterally.  No comment was made on limitations in motion from the CI’s weight.  

The panel directed attention to its rating recommendation based on the above evidence. The PEB rated the right knee condition 10%, coded 5299-5003 (arthritis, degenerative).  The Navy PEB also listed bilateral patella chondromalacia as a related Category II condition, (a condition that contributed to the primary unfitting condition but was not separately ratable).  The VA rated both the right knee and left knee conditions 10% each, and both coded 5010-5260, (arthritis due to trauma-leg, limitation of flexion of), based on the C&P examination 15 months after separation, citing painful limitation of motion on examination.  The CVA also rated each knee at 10% for instability coded 5257 (other impairment of the knee).  The panel first considered if each knee was separately unfitting.  Both had surgery and abnormal X-ray findings.  Both were profiled for chondromalacia patella (CMP) which the MEB was determined to fail retention standards.  The panel also noted that the MEB specifically cited the left knee osteoarthritis (OA) whereas the PEB specifically cited the right knee.  The evidence supported a finding that each knee was unfitting at separation.  The panel then considered the rating for each knee.  There was no limitation of motion which supported a rating under the diagnostic codes for limitation of flexion or extension (5260, 5261).  
There was evidence of painful motion with functional loss supporting a 10% rating (based on §4.59, §4.40 and §4.45).  The 5259 code (cartilage, semilunar, removal of, symptomatic) was also applicable in this case and was an alternate route to a 10% rating.  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 recommends a disability rating of 10% for the right knee condition and 10% for the left knee condition, both coded 5259.  The panel observed that the VA also rated each knee at 10% for instability.  Neither the PEB nor the MEB addressed instability.  Accordingly, it is outside the Scope of the panel.  The panel noted for the record though, that the knees were consistently recorded as stable at multiple orthopedic evaluations prior to separation.  Each knee had surgery at which time an examination under anesthesia would have been performed.  
Instability was not documented.  Accordingly, even were instability within Scope, the evidence would not support an additional rating for it at separation.  

Contended PEB Conditions:  Bilateral Ankle Arthritis and Low Back Pain.  The panel’s main charge is to assess the fairness of the PEB’s determination that the contended conditions were not unfitting.  Neither of the conditions was profiled or specifically implicated in the commander’s statement.  Both were judged to meet retention standards.  There was no performance-based evidence from the record that either of the conditions significantly interfered with satisfactory duty performance at separation.  After due deliberation, the panel concluded that there was insufficient cause to recommend a change in the PEB fitness determination for any of the contended conditions and so no additional disability ratings are recommended.  

BOARD FINDINGS:  In the matter of the right and left knee conditions and IAW VASRD §4.71a, the panel unanimously recommends separate disability rating of 10%, coded 5259 IAW VASRD §4.71a.  In the matter of the contended bilateral ankle arthritis and low back pain conditions, the panel unanimously recommends no change from the PEB determinations as not unfitting.  
There are no other conditions within the panel’s scope of review for consideration.  The panel recommends that the CI’s prior determination be modified as follows, effective as of the date of the prior medical separation:  

CONDITION	VASRD CODE	PERMANENT RATING	
Right Knee Osteoarthritis and Medial Meniscus Tear	5259	10%	
Left Knee Osteoarthritis and Medial Meniscus Tear	5259	10%	
COMBINED	20%	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20151229, with attachments
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record  

MEMORANDUM FOR DEPUTY COMMANDANT (Manpower and Reserve Affairs)
		   COMMANDER, NAVY PERSONNEL COMMAND	
	                          
Subj:  PHYSICAL DISABILITY BOARD OF REVIEW (PDBR) RECOMMENDATIONS          

Ref:  (a) DoDI 6040.44
	(b) PDBR ltr dtd 18 Aug 17 ICO XXXXXXXXXXXXXXXXXXX
	(c) PDBR ltr dtd 18 Aug 17 ICO XXXXXXXXXXXXXXXXXXX
	(d) PDBR ltr dtd 18 Aug 17 ICO XXXXXXXXXXXXXXXXXXX
	(e) PDBR ltr dtd 18 Aug 17 ICO XXXXXXXXXXXXXXXXXXX
	(f) PDBR ltr dtd 18 Aug 17 ICO XXXXXXXXXXXXXXXXXXX
	(g) PDBR ltr dtd 18 Aug 17 ICO XXXXXXXXXXXXXXXXXXX
	(h) PDBR ltr dtd 18 Aug 17 ICO XXXXXXXXXXXXXXXXXXX
	(i) PDBR ltr dtd 18 Aug 17 ICO XXXXXXXXXXXXXXXXXXX
	(j) PDBR ltr dtd 22 Aug 17 ICO XXXXXXXXXXXXXXXXXXX
	(k) PDBR ltr dtd 18 Aug 17 ICO XXXXXXXXXXXXXXXXXXX
	(l) PDBR ltr dtd 18 Aug 17 ICO XXXXXXXXXXXXXXXXXXX
	(m) PDBR ltr dtd 18 Aug 17 ICO XXXXXXXXXXXXXXXXXXX
	(n) PDBR ltr dtd 21 Aug 17 ICO XXXXXXXXXXXXXXXXXXX
	(o) PDBR ltr dtd 18 Aug 17 ICO XXXXXXXXXXXXXXXXXXX

1.  Pursuant to reference (a), the recommendations of the Physical Disability Board of Review set forth in references (b) through (o) are approved.  The official records of the following individuals are to be corrected as follows:

     a. XXXXXXXXXXXXXXXXXXX, former USN: Placement on the Permanent Disability Retired List with a 30 percent rating (increased from 20 percent) effective date of discharge.

     b. XXXXXXXXXXXXXXXXXXX, former USN: Entitlement to disability separation pay with a 20 percent disability rating (increased from 10 percent) effective date of discharge. 

     c. XXXXXXXXXXXXXXXXXXX, former USMC: Entitlement to disability separation pay with a 20 percent disability rating (increased from 10 percent) effective date of discharge. 

     d. XXXXXXXXXXXXXXXXXXX, former USMC: Entitlement to disability separation pay with a 20 percent disability rating (increased from 10 percent) effective date of discharge. 

     e. XXXXXXXXXXXXXXXXXXX, former USMC: Placement on the Permanent Disability Retired List with a 30 percent rating (increased from 10 percent) effective date of discharge.

     f. XXXXXXXXXXXXXXXXXXX, former USMC: Entitlement to disability separation pay with a 20 percent disability rating (increased from 0 percent) effective date of discharge. 

Subj:  PHYSICAL DISABILITY BOARD OF REVIEW (PDBR) RECOMMENDATIONS

     g. XXXXXXXXXXXXXXXXXXX, former USMC: Entitlement to disability separation pay with a 20 percent disability rating (increased from 10 percent) effective date of discharge. 

     h. XXXXXXXXXXXXXXXXXXX, former USN: Entitlement to disability separation pay with a 20 percent disability rating (increased from 10 percent) effective date of discharge. 

     i. XXXXXXXXXXXXXXXXXXX, former USMC: Placement on the Permanent Disability Retired List with a 30 percent rating (increased from 20 percent) effective date of discharge.

     j. XXXXXXXXXXXXXXXXXXX, former USMC: Entitlement to disability separation pay with a 20 percent disability rating (increased from 10 percent) effective date of discharge. 

     k. XXXXXXXXXXXXXXXXXXX, former USN: Entitlement to disability separation pay with a 20 percent disability rating (increased from 10 percent) effective date of discharge. 

     l. XXXXXXXXXXXXXXXXXXX, former USMC: Entitlement to disability separation pay with a 10 percent disability rating (increased from 0 percent) effective date of discharge. 

     m. XXXXXXXXXXXXXXXXXXX, former USMC: Entitlement to disability separation pay with a 10 percent disability rating (increased from 0 percent) effective date of discharge. 

     n. XXXXXXXXXXXXXXXXXXX, former USN: Placement on the Permanent Disability Retired List with a 30 percent rating (increased from 10 percent) effective date of discharge.
     
3.  Please take action to implement these decisions and provide notification to the above individuals once those actions are complete.

	XXXXXXXXXXXXXXXXXXX
	Acting