DEPARTMENT  OF  THE NAVY
SECRETARY OF THE NAVY COUNCIL OF REVIEW BOARDS 720 KENNON STREET SE STE 309 WASHINGTON NAVY YARD, DC 20374

IN   REPLY   REFER  TO:
1850
CORB:003
20 Feb 20

From: To:

Director, Secretary of the Navy Council of Review Boards 
PD-2016-01094

Subj:	PHYSICAL DISABILITY BOARD OF REVIEW (PDBR)

Ref:	(a) DoDI 6040.44
(b) PDBR ltr dtd 27 Sep 18

1.	Pursuant to reference (a), the PDBR reviewed your case and forwarded its recommendation (reference (b)) to the Department of the Navy.

2.	On 12 February 2020, the Assistant Secretary of the Navy (Manpower & Reserve Affairs) accepted the recommendation of the PDBR of no change to your characterization of separation or disability rating assigned by the Department of the Navy's Physical Evaluation Board.

3.	The Secretary's decision on your PDBR application is final and is not subject to appeal or additional review by the Board for Correction of Naval Records.

RECORD OF PROCEEDINGS PHYSICAL DISABILITY BOARD OF REVIEW
NAME:  XXXXXXXXXXXXXXX	CASE: PD-2016-01094
BRANCH OF SERVICE: NAVY	SEPARATION DATE: 20040115

SUMMARY OF CASE: Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E5, Minesweeping Boatswains Mate, medically separated for “right knee post traumatic degenerative joint disease” with a disability rating of 10%.

CI CONTENTION: “Member received right and left knee replacement.” 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 Medical Evaluation Board (MEB), but determined by the PEB 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. The panel’s authority is limited to assessing the fairness and accuracy of PEB rating determinations and recommending corrections when appropriate. The panel’s assessment of the PEB rating determination is based on review of medical records and all available evidence relevant to application of the Veterans Affairs Schedule for Rating Disabilities (VASRD) standards for 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, which operates 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 disability at the time of separation.

RATING COMPARISON:

SERVICE PEB - 20031112	VARD - 20050201	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Right Knee Post Traumatic Degenerative Joint Disease (DJD)	5010-5003	10%	

Right Knee DJD	

5010-5257	

10%	

20040317	
Right Knee S/P ACL Reconstruction	Cat II					
S/P Right Lateral Meniscus Repair	Cat II					
Right Knee S/P Partial Medial Meniscectomy X 2	Cat II					
COMBINED RATING: 10%	COMBINED RATING OF ALL VA CONDITIONS: 70%	

ANALYSIS SUMMARY:

Right Knee Post Traumatic DJD. According to the service treatment record and MEB narrative summary (NARSUM), the CI underwent anterior cruciate ligament (ACL) reconstruction in 1999. He subsequently underwent partial medial and lateral meniscus repair in March 2000. In October 2001, he underwent another arthroscopy for partial medial meniscectomy and the ACL was intact.       Knee X-rays on 29 April 2003 showed post-surgical changes with intact hardware and

degenerative changes of the knee and patella. The CI underwent subsequent hardware removal in July 2003 with concurrent arthroscopy, which showed no recurrent meniscal tears. At a sports clinic follow-up on 2 September 2003, the CI reported the knee buckled sometimes, without locking. A physical therapy examination on 23 September 2003 indicated mild limping was noted on the right with the first few steps.

During the 18 August 2003 MEB examination (recorded on DD Forms 2807-1 and 2808), 5 months prior to separation, the CI reported use of a right knee brace. The examiner noted the CI would not flex his knee more than 40 degrees. The 3 September 2003 MEB NARSUM examination, 4 months prior to separation, noted complaints of significant post-operative right knee pain. Physical examination showed tenderness at the tibia tubercle and patellofemoral compression pain, but the knee was stable.  Knee range of motion (ROM) was extension of 2 degrees (normal
0) and flexion of 130 degrees (normal 140).

At the 17 March 2004 VA Compensation and Pension (C&P) examination, 2 months after separation, the CI reported constant right knee pain with weakness, swelling, giving way, locking and redness of the scar area. He also reported wearing a right knee brace at all times. He denied stiffness, heat, fatigability, lack of endurance, dislocation or recurrent subluxation. Physical examination showed 0 degrees of extension and 130 degrees of flexion with pain throughout the entire ROM. There was no evidence of fatigue, weakness or lack of endurance after repetitive movement, and no evidence of tenderness, effusion, weakness instability, abnormal movement or guarding. The CI tended to limp on the right lower extremity and an examination of his shoes showed increased weight bearing on the left.

The panel directed attention to its rating recommendation based on the above evidence. The PEB rated the right knee condition 10%, dual coded 5010-5003 (traumatic arthritis and degenerative arthritis). The VA also rated the right knee condition 10%, dual coded 5010-5257 (traumatic arthritis-mild recurrent subluxation or lateral instability), based on the C&P examination, citing “functional loss to include weakness, fatigability with use, incoordination and painful motion.”

There was no limitation of motion on the examinations proximate to separation 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). 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. The 5259 code (cartilage, semilunar, removal of, symptomatic) was applicable in this case but the maximum 10% rating under that code provided no benefit to the CI. 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). There was therefore no VASRD §4.71a rating higher than 10% PEB rating under any applicable code. Although the panel arrived at the same rating using a different code, no change to the PEB’s coding choice is recommended since there is no benefit to the CI. After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the panel concluded there was insufficient cause to recommend a change in the PEB adjudication for the right knee condition.

BOARD FINDINGS: In the matter of the right knee condition and IAW VASRD §4.71a, the panel recommends no change in the PEB adjudication. There are no other conditions within the panel’s scope of review for consideration. Therefore, the panel recommends no modification or re- characterization of the CI’s disability and separation determination.