RECORD OF PROCEEDINGS PHYSICAL DISABILITY BOARD OF REVIEW

NAME: XXXXXXXXXXXXXXXX		CASE: PD-2017-00953 BRANCH OF SERVICE: NAVY	SEPARATION DATE: 20050425

SUMMARY OF CASE: Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E4, Field Medical Service Technician, medically separated for “medial meniscal tear” with a disability rating of 20%.

CI CONTENTION: Review of all conditions requested. The CI also requested review of additional conditions not identified by the Medical Evaluation Board (MEB) and Physical Evaluation Board (PEB).  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 PEB to be unfitting for continued military service, and when specifically requested by the CI, those conditions identified by the 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 - 20050105	VARD - 20050930	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Medial Meniscal Tear, Status Post Debridement (Right Knee)	5258	20%	
Status Post Medical Meniscal Repair and Anterior Cruciate Ligament Reconstruction (ACL) Right Knee	

5258	

20%	

20050606	
Right Knee Pain	Cat II					
Osteoarthritis of the Right Knee	Cat II					
ACL Deficient Right Knee, Status Post ACL Reconstruction	Cat II					
Lumbar Muscle Strain	Cat II	Lower Back Condition	5299-5237	NSC	20050602	
Glaucoma, Bilateral	Cat III	Glaucoma	6013	10%	20050615	
COMBINED RATING: 20%	COMBINED RATING OF ALL VA CONDITIONS: 50%	
	
ANALYSIS SUMMARY:

Right Knee Medial Meniscal Tear. According to the service treatment record and MEB narrative summary (NARSUM), the CI underwent three right knee arthroscopic surgeries (the first for ACL

reconstruction and last two on the medial meniscus that culminated in the partial removal) with the last occurring in April 2004. The CI was unable to continue performing his military duties due to the knee injury and persistent pain.

At the time of the orthopedic sports clinic appointment on 21 September 2004, 7 months prior to separation, the CI reported right knee instability and frequent episodes of unnatural motion and the knee “giving out” especially when climbing or descending stairs. Physical examination was negative for crepitus and the patellar grind test was negative. Lachman’s test was less than 5 mm with a stable endpoint and neutral alignment. Pivot test was negative. Varus and valgus tests were stable. Right knee range of motion (ROM) was reported as full. At the time of the orthopedic sports clinic appointment over a week later, the CI reported significant pain (6/10) in his right knee. The opinion rendered recommended no revision of the ACL and suggested the preponderance of his symptoms were coming from the arthritic changes seen on radiographs and by the most recent MRI. He continued to take Vicodin and Motrin. The examiner stated that even though the CI had a lot of pain and feelings of instability, his ACL was intact and seemed solid. The knee was looser than normal, but did not meet criteria for revision.

The 21 October 2004 MEB NARSUM examination, 6 months prior to separation, noted complaints of right knee pain. He rated the pain at 6-7/10 and continued to take both Motrin and Roxicet as needed. He was unable to perform any recreational athletics or any command physical training. Physical examination showed a slight limp and had obvious asymmetry between the right and left knee. There was a solid endpoint with asymmetry of Lachman examination between the right and left unaffected side. There was no pivot shift. He had significant medial joint line tenderness and pain along the course of the pes tendon, but no apprehension or mal tracking of the patellofemoral joint. No anterior knee symptoms or lateral joint line tenderness were observed. Right knee ROM showed flexion of 125 degrees (normal 140) and extension was full.

At the 6 June 2005 VA Compensation and Pension (C&P) examination, approximately one month after separation, the CI reported a constant, dull, deep, non-radiating 4/10 pain that increased to 7/10 when climbing stairs. He denied weakness, edema, and flare-ups, but reported decreased ROM, and stiffness and locking, occurring approximately two times per month. Physical examination showed the CI had a mild antalgic gait. His knees appeared symmetrical, measuring
44.5	cm on the right and 42.5 cm on the left. There was no obvious swelling or effusions. There was crepitus bilaterally and he had joint line tenderness and tenderness to palpation of his patella on the right greater than the left. He had a stable varus and valgus stress bilaterally and a negative McMurray’s, Lachman’s and anterior and posterior drawers testing bilaterally. Deep tendon reflexes were 2+ and muscle strength was 5/5 including his quads. There was no weakness, fatigue or incoordination. Right knee ROM showed flexion of 80 degrees and extension of 0 degrees (normal). X-rays on 6 June 2005, one month after separation, revealed no evidence of fracture or degenerative change. Joint compartments were well preserved. The CI had spurs in the distal femur and proximal tibia from an ACL repair. The impression was post- operative changes; otherwise, it was an unremarkable knee.

The panel directed attention to its rating recommendation based on the above evidence. The PEB rated the right knee condition 20%, coded 5258 (cartilage, semilunar, dislocated, with frequent episodes of “locking,” pain and effusion into the joint). The VA also rated the condition 20%, using the same code (5258), based on the C&P examination, citing frequent episodes of “locking,” pain and effusion into the joint.

The panel agreed there was history and evidence of dislocated meniscus or loose body causing frequent locking with recurrent effusions (5258), to support a 20% 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). No additional functional limitation was evidenced by the examinations. There is therefore no VASRD

§4.71a rating higher than the 20% adjudicated by the PEB under any applicable code. The panel agreed that the three additional diagnoses determined to be Category II conditions (those which contributed to the primary unfitting condition but were not separately ratable) were an intertwined diagnoses, and the overall knee impairment from all listed diagnoses was subsumed under the ratings for the knee by both the PEB and the VA. More than one rating based on the same impairment is prohibited, IAW §4.14 (avoidance of pyramiding). After due deliberation, considering all 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.

Contended PEB Conditions: Lumbar Muscle Strain and Glaucoma. The panel’s main charge is to assess the fairness of the PEB determination that the contended conditions were not unfitting. Neither of the conditions were noted on limited duty forms or implicated in the non-medical assessment and they did not fail retention standards. There was no performance-based evidence from the record that any of the conditions significantly interfered with satisfactory duty performance at separation. After due deliberation, the panel concluded there was insufficient cause to recommend a change in the PEB fitness determination for any of the contended conditions, so no additional disability ratings are recommended.

BOARD FINDINGS: In the matter of the right knee condition and IAW VASRD §4.71a, the panel recommends no change in the PEB adjudication. In the matter of the contended lumbar muscle strain and glaucoma conditions, the panel recommends no change from the PEB determination as not unfitting.

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) PDBRltr

1.	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 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.