IN   REPLY   REFER  TO:

20 Feb 20

From: To:

Director, Secretary of the Navy Council of Review Boards 
PD-2017-02045

Subj: Ref:

PHYSICAL DISABILITY BOARD OF REVIEW (PDBR)

(a) DoDI 6040.44
(b)	PDBR ltr dtd 18 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-2017-02045
BRANCH OF SERVICE: NAVY	SEPARATION DATE: 20060501

SUMMARY OF CASE: Data extracted from the available evidence of record reflects this covered individual (CI) was a Reserve E5, Aviation Electrician, medically separated for “right anterior cruciate ligament insufficiency s/p anterior cruciate ligament [ACL] reconstruction” with a disability rating of 10%.

CI CONTENTION:  No specific contention was made.  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 - 20060313	VARD - 20070507	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Rt ACL Insufficiency S/P ACL Reconstruction	5299-
5257	10%	
Traumatic Arthritis, Rt Knee	
5010	
20%	
20060811	
S/P Rt Partial Medial and Lateral Meniscectomies	Cat II					
Rt Tricompartmental DJD	Cat II					
COMBINED RATING: 10%	COMBINED RATING OF ALL VA CONDITIONS: 20%	

ANALYSIS SUMMARY:

Right ACL Insufficiency S/P ACL Reconstruction. According to the service treatment record (and MEB narrative summary (NARSUM), the CI’s right ACL insufficiency condition began in 1986 when the CI sustained a twisting injury to the right knee. Treatment was conservative and the diagnosis ACL insufficiency was made in January 2005.          The CI underwent an ACL reconstruction with

hamstrings autograft as well as partial, medial, and lateral meniscectomies and abrasion chondroplasty of her patella and medial and lateral femoral condyles.

The 7 February 2006 MEB NARSUM examination, 3 months prior to separation, noted complaints of pain, weakness, and loss of range of motion (ROM). Physical examination showed mild quadriceps atrophy with mild to moderate effusion. ROM showed normal extension and 115 degrees of flexion (normal 140). Global tenderness to the retinaculum medially, laterally and anteriorly was noted. Positive patellar grind was present, but various knee testing (Lachman’s, pivot shift, varus and valgus) was negative.  Neurovascular was intact.

At the 11 August 2006 VA Compensation and Pension (C&P) examination, 3 months after separation, the CI reported persistent pain in the right knee but no instability or locking. No protective brace was worn, and she walked and was able to do her exercises without any type of assistance. Physical examination showed a normal gait, no effusion, evidence of patellar instability, popliteal swelling, and no erythema or warmth. ROM showed flexion at 120 degrees and extension at 0 degrees.  No change with repetitive motion or instability was noted.

The panel directed attention to its rating recommendation based on the above evidence. The PEB rated the right ACL insufficiency condition 10%, analogously coded as 5257 (knee, other impairment). The PEB listed the S/P right partial medial and lateral meniscectomies and right tri- compartmental degenerative joint disease (DJD) conditions as a related diagnosis (Category II) that contributed to the disability in this case. The panel agreed that the Category II conditions were diagnoses related to the right ACL insufficiency and were not separate conditions which could be separately rated IAW §4.14 (avoidance of pyramiding; more than one rating based on the same impairment is prohibited). The VA rated the traumatic arthritis, right knee condition 20%, coded 5010 (arthritis, due to trauma) as a continuation from previous rating, however, they proposed decreasing it to 10% based on the C&P examination citing painful motion and flexion of 120 degrees.

The panel noted there was no limitation of motion which supported a rating under the diagnostic codes for limitation of flexion or extension (5260, 5261). The persistence of pain after meniscal surgery warranted a 10% rating under the 5259 code (cartilage, semilunar, removal of symptomatic) as adjudicated by the PEB. The examinations proximate to separation did not demonstrate the presence of ligamentous instability or laxity (5257), but there was slight laxity supporting the 10% rating. There was no history of dislocated meniscus or loose body causing frequent locking with recurrent effusions (5258) for a higher rating. There was 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 right ACL insufficiency condition.

BOARD FINDINGS: In the matter of the right anterior cruciate ligament insufficiency 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 20170315, w/atchs Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Record