RECORD OF PROCEEDINGS PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXXXXX		CASE: PD-2017-01550 BRANCH OF SERVICE: COAST GUARD	SEPARATION DATE: 20080610

SUMMARY OF CASE: Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E4, Gunner’s Mate, medically separated for “cartilage, semilunar, removal of, symptomatic [left knee]” with a disability rating of 10%.

CI CONTENTION: Review requested of the left knee, which continues to have issues, as well as additional conditions not identified by the Medical Evaluation Board (MEB) and Physical Evaluation Board (PEB) was 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 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 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 - 20071017	VARD - NA	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Removal of Semilunar Cartilage, Symptomatic (Left Knee)	5259	10%	No VA Examination Proximate to Separation in Evidence	
COMBINED RATING: 10%	COMBINED RATING OF ALL VA CONDITIONS: NA	

ANALYSIS SUMMARY:

Left Knee Pain. According to the service treatment record and MEB narrative summary (NARSUM), the CI underwent multiple left knee surgeries, the last being in March 2007. Despite physical therapy (PT), medication and use of assistive devices, he was unable perform his military specialty duties. At a 27 April 2007 primary care clinic visit, examination revealed full left knee range of motion (ROM) with tenderness on extension and with palpation of the medial lower patella. By June 2007, he had no tenderness, edema, ecchymosis, or erythema of the knee. Muscle strength was normal, and there was full ROM with no instability, laxity, crepitus, or evidence of a meniscal tear. At a clinic visit on 11 July 2007, the CI reported that after a 2-day trial back to full duty and boarding vessels, he experienced knee “trouble” with some minor buckling despite use of a hinged brace. On examination, he had a normal gait with some edema and crepitus at the inferior patellar region. Active ROM was limited, “but not full,” with a negative drawer test (to determine instability) and normal strength. On 19 July 2007, he was placed on limited duty with no prolonged standing/walking and no climbing.

The 17 August 2007 MEB NARSUM examination, 10 months prior to separation, noted complaints of persistent knee pain and recurrent knee swelling with increased activity. He was not able to climb or tolerate prolonged lifting and standing. The 10 October 2007 MEB NARSUM addendum, 8 months before separation, referenced the CI’s most recent orthopedic ambulatory surgery visit on 3 October 2007, where the specialist noted he was able to do most activities, but “unable to do activities requiring persistent running, climbing stairs or lifting any heavy objects requiring use of his left knee…” Physical examination noted full ROM with “rock solid stability” on Lachman’s and anterior drawer tests, with no significant effusion or joint line tenderness. There was no VA examination proximate to separation in evidence, but at a fire fighter/medic placement evaluation on 8 July 2008, 1 month after separation, the CI annotated “no complications” from his previous surgeries, and the physician marked that the “examinee is qualified to physically perform job activities identified by employer request form without restrictions.”

The panel directed attention to its rating recommendation based on the above evidence. The PEB rated the left knee condition 10%, coded 5259 (cartilage, semilunar, removal of, symptomatic). Panel members agreed that the persistence of pain after meniscal surgery warranted a 10% rating under code 5259, however, there was no limitation of flexion or extension (5260 or 5261), or evidence of recurrent subluxation or lateral instability (5257) to support higher ratings. 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 §4.71a, 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.

·@:

U:S. Department o · Homeland Security
United States	-
Coast Guard

Commandant
United States Coast Guard

Mail Stop 7907
2703 Martin Luther King Jr. Ave SE Washington, DC 20593-7907
Staff Symbol: CG-1 Phone: (202) 475-5000

1850
MAR 2 7 2020

Dear XXXXXXXX,

I am the Designated Decision Authority for the Coast Guard on applications submitted to the Department of Defense Physical Disability Board of Review (PDBR). Under the authority of Title 10, United States Code, section 1554a, I accept the PDBR's recommendation in your case (Case Number PD-2017-01550) and decline to modify your findings.

Enclosed for your information are a copy of the PDBR' s recommendation and a copy of the record of proceedings.

A copy of this decision has also been provided to Coast Guard Enlisted Personnel Management Branch, the PDBR, and the Department of Veterans Affairs.

If you have any further questions, please contact the Coast Guard Personnel Service Center at (202)795-6645.