RECORD OF PROCEEDINGS PHYSICAL DISABILITY BOARD OF REVIEW
NAME: XXXXXXXXXXXXXXXXXXXXX	CASE: PD-2017-00477
BRANCH OF SERVICE: NAVY	SEPARATION DATE: 20060620

SUMMARY OF CASE: Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E5, Navigation Equipment Maintenance Technician, medically separated for “osteoarthritis bilateral knees” 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 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 - 20060302	VARD - 20070823	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Osteoarthritis Bilateral Knees	5299-5003	10%	Left Knee Osteoarthritis	5260-5010	10%	STR	
			Right Knee Osteoarthritis	5260-5010	10%	STR	
COMBINED RATING: 10%	COMBINED RATING OF ALL VA CONDITIONS: 10%	

ANALYSIS SUMMARY:

Osteoarthritis Bilateral Knees. The PEB combined the left and right knee conditions as a single unfitting condition coded analogously to 5003 (arthritis, degenerative) and rated 10%. The approach by the PEB not uncommonly reflected its judgment that the constellation of conditions was unfitting, and there was no need for separate fitness adjudications. The panel also noted that “bundling,” the combining of two or more major joints, may be permissible under the VASRD 5003 rating requirements, and that this approach does not compromise the VASRD §4.7 directive to choose the higher of two valid ratings. The panel’s initial charge in this case was therefore directed at determining if the PEB’s approach of combining conditions under a single rating was

justified in lieu of separate ratings. When considering a separate rating for each condition, the panel considers each bundled condition to be reasonably justified as separately unfitting unless a preponderance of evidence indicates the condition would not cause the member to be referred into the DES or be found unfit because of physical disability. When the panel recommends separate fitness recommendations in this circumstance, its recommendations may not produce a lower combined rating than that of the PEB.

According to the service treatment record (STR) and MEB narrative summary (NARSUM), the CI underwent a left anterior cruciate ligament (ACL) reconstruction in 2000, which was followed up with a repeat left knee arthroscopy in 2001 for debridement of an ACL lesion. He subsequently developed bilateral patellofemoral joint pain; an MRI showed some medial meniscus signal changes, but no definitive tear, and an intact ACL graft with no osteochondral lesions. An orthopedic evaluation in December 2005 showed right and left knee flexion of 110 degrees (normal 140) and left knee extension of 5 degrees (normal 0). The left knee demonstrated crepitus and one plane of posterior instability, but was otherwise ligamentously stable.

The 5 December 2005 MEB NARSUM examination, 6 months prior to separation, noted complaints of bilateral knee pain while walking or navigating stairs. On examination, both knees were ligamentously stable, with no joint line tenderness, and bilateral knee range of motion (ROM) was from 0-120 degrees, with crepitus, but no mention of painful motion. Radiographs showed mild degenerative changes, most notably in the patellofemoral and medial compartments of the knees. There was no VA examination proximate to separation in evidence.

The panel directed attention to its rating recommendation based on the above evidence. The PEB rated the bilateral knee condition 10%, analogously coded 5299-5003. The VA rated the left and right knees 10% each, both dual coded 5260-5010 (limitation of leg motion due to traumatic arthritis), based on the STR, citing arthritis in a major joint with painful motion. Panel members agreed the evidence reasonably justified that the functional limitations of the left and right knee conditions contributed to the CI’s inability to perform his military duties, and accordingly separate disability ratings are recommended for each knee.

Although there were X-ray findings of mild degenerative arthritis of the knees to support a 10% rating using code 5003, there was no limitation of flexion or extension for either knee that supported a rating under codes 5260 or 5261. 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) to support a rating under the respective codes for either knee. 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) for either leg. Additionally here was no evidence of painful motion with functional loss supporting a 10% rating (based on §4.59, §4.40 and §4.45) for either knee. 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 bilateral knee condition.

BOARD FINDINGS: In the matter of the bilateral 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.

The following documentary evidence was considered:

Exhibit A. DD Form 294, dated 20170219, w/atchs Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Record

DEPARTMENT OF THE NAVY
SECRETARY OF THE NAVY COUNCIL OF REVIEW BOARDS 720 KENNON STREET SE STE 309
WASHINGTON NAVY YARD, DC 20374-5023

IN   REPLY  REFER  TO ,
1850
CORB: 003 20May20

From: 

Director, Secretary of the Navy Council of Review Boards 

Subj:  PHYSICAL DISABILITY BOARD OF REVIEW  (PDBR)

Ref:	(a) DoDI 6040.44
(b) PDBR ltr dtd 24 Oct 18

I.	Pursuant to reference (a), the PDBR reviewed your case and forwarded its recommendation (reference (b)) to the Department of the Navy on 5 Mar 2020 for appropriate  action.

2.	On 20 March 2020, the Assistant Secretary of the Navy (Manpower & Reserve Affairs) accepted the recommendation of the PDBR ofno 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.