RECORD OF PROCEEDINGS PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXX		CASE: PD-2017-03042 BRANCH OF SERVICE: NAVY	SEPARATION DATE: 20061206

SUMMARY OF CASE: Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E3, MH-53E Systems Organizational Maintenance Technician, medically separated for “right knee pain” with disability rating of 10%.

CI CONTENTION: “I still have moderate to severe pain.” 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 - 20061016	VARD - 20070424	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Right Knee Pain	5099-5003	10%	Right Knee, Status Post Anterior Cruciate Ligament (ACL) Repair	5262	10%	20070325	
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 right knee surgery with ACL and meniscal repairs on 7 December 2005, with screw modification on 9 December 2005. In March 2006, at an orthopedic clinic visit, the CI reported that his right knee gave out approximately three times a week. Range of motion (ROM) measurements were flexion of 120 degrees (normal 140) and extension of 0 degrees (normal 0). Sports medicine did a right knee ROM test in April 2006, which showed flexion of 130 degrees and extension of minus 5 degrees. The Lachman’s test (to determine instability) showed 2 mm motion with solid support, and there was fair quadriceps tone and control.  At a   physical

therapy clinic visit on 10 June 2006, the CI was noted to have mild quadriceps atrophy, slight hamstring atrophy and “poor” one leg hop, but was able to squat.

The 8 August 2006 MEB NARSUM examination, 4 months prior to separation, noted complaints of pain with activity including running, prolonged standing, prolonged walking, squatting or kneeling. Physical examination showed tenderness about the anterior incision site. He had good quadriceps tone with some atrophy. Right knee ROM testing showed flexion of 130 degrees and extension of minus 5 degrees. He had a Lachman test of 10 mm of solid endpoint and was stable to varus and valgus.

At the 25 March 2007 VA Compensation and Pension (C&P) examination, 3 months after separation, the CI reported right knee pain with a severity of 2-3/10 and flare-ups three to four times a week with weakness, stiffness, instability, giving way and lack of endurance. The examiner noted the CI had a normal stance and a rapid gait, but used a right knee orthotic brace. Physical examination showed tenderness over the entire inferior patellar tendon and mild subpatellar and parapatellar pain, but no effusion, crepitus (grinding sensation), patellar compression, ligamentous instability or meniscal pathology. The ROM evaluation showed right knee flexion of 138 degrees and extension of 0 degrees after multiple repetitions with no pain, weakness or fatigue noted. X-rays showed fixation screws that corresponded to the prior surgery. The right knee and patellofemoral joint spaces appeared adequate and there was no fracture or dislocation.

The panel directed attention to its rating recommendation based on the above evidence. The PEB rated the right knee condition 10%, analogously coded 5099-5003 (arthritis, degenerative). The VA also rated the right knee condition 10%, coded 5262 (knee, ankylosis of), based on the C&P examination, citing malunion of the tibia and fibula with slight knee disability.

The panel agreed there was no limitation of flexion or extension that supported a rating under the VASRD diagnostic codes for limitation of motion (5260 or 5261). The persistence of pain after meniscal surgery warranted a 10% rating under the 5259 code (cartilage, semilunar, removal of symptomatic), but provided no rating benefit to the CI. There was no history or evidence of dislocated meniscus or loose body causing frequent locking with recurrent effusions (5258) to support a rating under that code. 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. There is 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:

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)PDBRltrdtd 14May 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 for 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.

Copy to: PDBR