RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXX	CASE:  PD-2017-01143
BRANCH OF SERVICE:  Navy 	SEPARATION DATE:  20091105

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E-4, Gas Turbine Systems Technician, medically separated for “status post [s/p] ACL reconstruction with chronic knee pain and effusion” with a disability rating of 0%.   

CI CONTENTION:  Review of all conditions requested.  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 - 20090708	VARD - 20100331	
Condition	Code	Rating	Condition	Code	Rating	Exam	
S/P ACL Reconstruction with Chronic Knee Pain and Effusion	5099-5003	0%	Left Knee Strain, S/P ACL Tear and Reconstruction	5257	10%	20100125	
COMBINED RATING:  0%	COMBINED RATING OF ALL VA CONDITIONS:  10% 	

ANALYSIS SUMMARY:  

Status Post (S/P) Anterior Cruciate Ligament (ACL) Reconstruction with Chronic Knee Pain and Effusion (Left Knee Pain).  According to the service treatment record and MEB narrative summary (NARSUM), the CI underwent ACL reconstruction surgery in November 2004 after experiencing a twisting injury during a basketball game.  The CI was subsequently separated from the Marine Corps on 15 April 2006 due to disability, and awarded a 0% rating for his left knee from a PEB which convened on 7 February 2006.  The CI was permitted to return to active duty (Navy) on 11 February 2008 and he was subsequently medically separated again by a PEB which convened on 8 July 2009 for his left knee.  The CI’s most recent medical separation date in this case is November 2009 and the record did not include any MEB documentation within 2 years of separation, nevertheless the panel focused its attention on evidence within 2 years prior and one year after November 2009.  

At the physical therapy examination on 4 March 2009, 8 months prior to separation, the CI complained of left knee pain.  Physical examination showed the CI ambulating into the clinic unassisted.  Range of motion (ROM) of the left knee was 130 degrees of flexion (normal 140) and 0 degrees extension (normal).  The 2 July 2009 orthopedic clinic examination, 4 months prior to separation, recorded the CI saying he would not be able to return to full duty as his knee felt no better post ACL reconstruction.  Physical examination indicated full ROM of the left knee with no swelling and slight anterior laxity.  

At the 25 January 2010 VA Compensation and Pension (C&P) examination, 3 months after separation, the CI reported occasional pain in the left knee, but no swelling or locking.  Prolonged walking caused discomfort.  He was not being medically followed nor was he taking any medication for the knee.  Physical examination showed no evidence of capsular thickening, joint effusion, or crepitus.  ROM was 0 degrees extension and 120 flexion without painful limitation.  The collateral ligaments were intact.  McMurray's sign was negative. There was no laxity of the anterior cruciate and there was no rotatory instability.  Repetitive motion tests for DeLuca factors were negative.  

At the 12 April 2010 orthopedic clinic examination, 5 months after separation, the CI reported pain with squatting and lifting and minimal discomfort at rest.  Physical examination showed a well-healed incision about the left knee, with no swelling or effusion.  ROM was 0 degrees extension and 130 degrees flexion.  Joint line tenderness was recorded.  Tibial hardware was prominent and tender.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the left knee pain 0%, analogously as 5003 (arthritis, degenerative).  Of note, the PEB originally rated the left knee 10% but then reduced this rating by 10% for EPTS [existed prior to service] with no service aggravation) factors.  The VA rated the left knee pain 10%, coded 5257 (knee, other impairment of:  recurrent subluxation or lateral instability) based on the C&P examination, citing objective evidence of painful motion.  

There was no evidence of painful motion with functional loss supporting a 10% rating (based on §4.59, §4.40 and §4.45).  There likewise was no limitation of motion which attained a 10% rating under the diagnostic codes for limitation of flexion or extension (5260, 5261).  There was no history or evidence 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 that those codes.  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.  However, the panel determined there was no clear and convincing evidence in the record which demonstrated that the CI had a 10% disabled left knee at the time he reenlisted on 11 February 2008.  The mere presence of his medical discharge for this same knee as of 15 April 2006 does not meet this standard of evidence, given there was no corroborating evidence leading up to or at the time of his reenlistment some 2 years later.  Therefore the panel concluded the EPTS deduction by the PEB was not supported by the evidence of record.  Further, although the evidence at the time of the CI’s separation on 4 November 2009 does not meet the 10% level for the CI’s disabled left knee, the panel cannot support the PEB’s 10% EPTS deduction at that time and therefore recommends the original 10% disability rating recommended by the PEB stand as final in this case.  After due deliberation, considering all the evidence and mindful of VASRD §4.3 (reasonable doubt), the panel recommends a disability rating of 10% for the left knee pain, coded 5099-5003.  
BOARD FINDINGS:  In the matter of the left knee pain, the panel recommends a disability rating of 10%, coded 5099-5003 IAW VASRD §4.71a.  There are no other conditions within the panel’s scope of review for consideration.  The panel recommends the CI’s prior determination be modified as follows, effective the date of medical separation:  

CONDITION	VASRD CODE	PERMANENT RATING	
Status Post ACL Reconstruction with Chronic Knee Pain and Effusion	5099-5003	10%	

MEMORANDUM FOR DEPUTY COMMANDANT (Manpower and Reserve A£fairs) COMMANDER, NAVY PERSONNEL COMMAND
Subj:		PHYSICAL DISABILITY BOARD OF REVIEW (PDBR) RECOMMENDATIONS Ref:	(a) DoDI 6040.44

(b)	PDBR ltr dtd 18 Oct 18 ICO XXXXXXXXXX

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

a.	XXXXXXXXXX: Entitlement to disability separation pay with a 10 percent disability rating (increased from
o  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.