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

From: To:

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

Director, Secretary of the Navy Council of Review Boards 
PD-2017-01181

Subj:	PHYSICAL DISABILITY BOARD OF REVIEW (PDBR)

Ref:	(a) DoDI 6040.44
(b) PDBR ltr dtd 22 Feb 19

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:  XXXXXXXXXXXXXXXX	CASE: PD-2017-01181
BRANCH OF SERVICE: NAVY	SEPARATION DATE: 20070904

SUMMARY OF CASE: Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E4, Aviation Ordnanceman, medically separated for “left knee pigmented villonodular synovitis [PVS]” with a disability rating of 10%.

CI CONTENTION: The condition continues to worsen and negatively impacts daily activities. 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 - 20070611	VARD - 20080327	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Left Knee PVS	5257	10%	Residuals, PVS	5261	10%	20080211	
Plica Syndrome, Left Knee	Cat II					
COMBINED RATING: 10%	COMBINED RATING OF ALL VA CONDITIONS: 20%	
	
ANALYSIS SUMMARY:

Left Knee PVS. According to the service treatment record (STR) and MEB narrative summary (NARSUM), the CI’s left knee condition began in 2001 after insidious onset and he underwent a surgical procedure in 2006. It was thought to be a success and recurrence was unlikely. The February 2007 orthopedics examination noted some stiffness and tightness with very good healing.  The CI reported anterior knee pain and stiffness on follow-up examination in April 2007.

The 1 May 2007 MEB NARSUM examination, 4 months prior to separation, noted complaints of left knee pain. The CI reported he was unable to run or perform other Soldier activities. Physical

examination of the left knee showed stable ligaments. Although gait was within normal limits, the CI had a mild limp. Range of motion (ROM) testing showed 120 degrees of flexion (normal 140).

At the 11 February 2008 VA Compensation and Pension (C&P) examination, 5 months after separation, the CI reported continued left knee pain, limited ROM, giving way, daily episodes of stiffness, decreased mobility, lack of stamina and constant effusion. The CI denied dislocation, subluxation, weakness and instability. He was able to walk more than a quarter mile but less than one mile. He wore a brace intermittently but frequently. The CI worked as a security guard and rode in a truck. Getting in and out of the truck 18-20 times per night increased his pain. The knee also became stiff after sitting for 45 minutes. Physical examination showed a limp with abnormal weight bearing, demonstrated by callus formation on the medial edge of the right great toe, but shoe wear pattern was not abnormal. Flexion was measured at 75 degrees without pain. There was atrophy of the left leg demonstrated by left quadriceps of 52.5cm at 8cm proximal to the knee compared to right quadriceps of 56cm at 8cm proximal to the knee.

The panel directed attention to its rating recommendation based on the above evidence. The PEB rated the left knee condition 10%, coded 5257 (knee, other impairment of: recurrent subluxation or lateral instability). The PEB listed “plica syndrome, left knee” as a related diagnosis (Category II) contributing to the disability in this case. The panel concluded the Category II diagnosis was not a separate condition which could be reasonably justified as separately unfitting; nor would a separate rating be achievable without pyramiding (VASRD §4.14). The VA also rated the left knee condition 10%, coded 5261 (limitation of leg extension), based on the C&P examination, citing painful and limited motion.

There was no limitation of motion 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). 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), or history of surgery to remove a meniscus (5259) to support a rating under the respective codes. There was no fracture, non-union or mal union 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 the 10% adjudicated by the PEB under any applicable code, and no grounds for additional rating based on the presence of instability. 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 left knee condition.

BOARD FINDINGS: In the matter of the left knee condition and IAW VASRD §4.71, 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.