RECORD OF PROCEEDINGS PHYSICAL DISABILITY BOARD OF REVIEW
NAME:  XXXXXXXXXXXXXXXX	CASE: PD-2017-02789
BRANCH OF SERVICE: NAVY	SEPARATION DATE: 20071128

SUMMARY OF CASE: Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E3, Crew Member, medically separated for “pain right knee” with a disability rating of 10%.

CI CONTENTION: “Constant knee and back pain, knee continues to collapse.” 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 - 20071018	VARD - 20080522	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Pain Right Knee	5299-5003	10%	
Status Post ORIF, Right Patella	
5260	
10%	
20080226	
Weakness Right Leg	Cat II					
Fracture Right Patella, S/P ORIF	Cat II					
COMBINED RATING: 10%	COMBINED RATING OF ALL VA CONDITIONS: 10%	
	
ANALYSIS SUMMARY:

Right Knee Pain. According to the service treatment record and MEB narrative summary (NARSUM), the CI underwent ORIF (open reduction internal fixation) of the right patella in April 2006 after a fall. The surgical fixation hardware was removed in March 2007. The 13 June 2007 MEB NARSUM examination, 5 months prior to separation, noted complaints of right knee pain. Physical examination showed notable right leg limping and weakness. The right thigh showed decreased muscle tone, bulk and mass when compared to the left.         Range of motion (ROM)

testing of the right knee showed flexion of 130 degrees (normal 140) limited by weakness of the quadriceps group and pain. The 22 June 2007 MEB NARSUM addendum, 5 months prior to separation, noted complaints of right knee pain. Physical examination revealed a normal gait. Right knee ROM testing showed flexion of 135 degrees and extension of 0 degrees (normal). The examiner  noted  pain  with  patellar  compression  and  pain  over  the  patellar  tendon.  The  13 September 2007 MEB NARSUM addendum, 2 months prior to separation, noted complaints of quadriceps weakness as well as anterior knee pain. Physical examination showed tenderness at the insertion of the quadriceps tendon into the patella and mild tenderness over the patellar tendon, but the CI had good patellar mobility. There was atrophy of the right quadriceps and motor strength in the right quadriceps was approximately 3+/5. Right knee ROM, following repetitive movement, showed flexion of 140 degrees and extension of 0 degrees.

At the 26 February 2008 VA Compensation and Pension (C&P) examination, 3 months after separation, the CI reported loss of strength in his quadriceps muscle and occasional giving-out of his right knee. The ROM evaluation, following repetitive movement, showed right knee flexion of 140 degrees and extension of 0 degrees without painful motion.

The panel directed attention to its rating recommendation based on the above evidence. The PEB rated the right knee condition 10%, analogously coded 5299-5003 (arthritis, degenerative). The PEB listed “weakness right leg” and “fracture right patella, S/P ORIF” as related diagnoses (Category II) contributing to the disability in this case. The panel concluded the Category II diagnoses were not separate conditions which could be reasonably justified as separately unfitting; nor would separate ratings be achievable without pyramiding (VASRD §4.14). The VA also rated the right knee condition 10%, coded 5260 (leg, limitation of flexion of), based on the C&P examination, citing functional loss due to pain, fatigue and weakness.

There was no limitation of motion which supported a 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 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). Although there was no evidence of painful motion, there was evidence of right knee pain with functional loss, but this provided no rating benefit to the CI. There was therefore no VASRD §4.71a rating higher than the 10% adjudicated by the PEB under any applicable code. 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.

BOARD FINDINGS: In the matter of the right 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.

The following documentary evidence was considered:

Exhibit A. DD Form 294, dated 20170418, w/atchs Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Record

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) PDBR ltr dtd 21 Apr 19

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.