RECORD OF PROCEEDINGS PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXX		CASE: PD-2017-03178 BRANCH OF SERVICE: NAVY	SEPARATION DATE: 20050530

SUMMARY OF CASE: Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E5, Advanced Biomedical Equipment Systems Technician, medically separated for “degenerative arthritis, right knee” and “osteochondral defect, lateral femoral condyle, left knee,” rated 10% and 10%, respectively, with a combined disability rating of 20%.

CI CONTENTION: “The PEB did not use all the available medical evidence to adjudicate my case.” 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 - 20050128	VARD - 20050830	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Degenerative Arthritis, Right Knee	5099-5003	10%	Degenerative Arthritis, Right Knee	5099-5003	10%	20050228	
Osteochondral Defect, Lateral Femoral Condyle, Left Knee	5099-5003	10%	Osteochondral Defect, Lateral Femoral Condyle, Left Knee	5099-5003	10%	20050228	
COMBINED RATING: 20%	COMBINED RATING OF ALL VA CONDITIONS: 40%	
	
ANALYSIS SUMMARY:

Degenerative Arthritis, Right Knee and Osteochondral Defect, Lateral Femoral Condyle, Left Knee. The evidence for the right and left knee conditions is presented together with attendant separate rating recommendations.   According to the service treatment record (STR) and MEB    narrative

summary (NARSUM), the CI underwent right knee surgery in May 2004 for repair of cartilage due to removal of a loose body and an osteochondral defect of the posterior aspect of the lateral femoral condyle. The CI underwent postoperative physical therapy and during that time he reported occasional left knee pain.

At an orthopedic examination on 12 August 2004, 10 months before separation, the CI reported right knee pain with occasional clicking and popping, and increasing left knee pain. Physical examination of the right knee revealed no patellar grind, a normal patellar tilt (normal alignment), and positive meniscus impairment testing. Right knee flexion was 140 degrees (normal) and extension was 0 degrees (normal) with painful motion. The left knee examination showed no patellar grind as well as normal patellar tilt and meniscus impairment testing. Left knee flexion was 140 degrees and extension was 0 degrees. Painful motion was not addressed. Bilateral knee strength was normal and there was no instability. At an orthopedic clinic visit on 17 November 2004, the examiner reported a left knee MRI which showed an osteochondral defect of the posterior aspect of the lateral femoral condyle, which he indicated was identical to the right knee lesion, and there was also chondromalacia of the patellofemoral and medial compartments.

During the 17 November 2004 MEB NARSUM, 7 months prior to separation, the CI reported right and left knee pain especially with activity. Physical examination revealed no bilateral knee instability and no effusion (fluid in or around the knees). Bilateral patellar (kneecap) motion and tilt testing were normal, and meniscus impairment testing was positive for pain. Bilateral knee flexion was 130 degrees and extension was 0 degrees. Painful motion and gait were not addressed. At a rheumatology clinic visit on 24 February 2005, right knee crepitus (grinding sensation) was noted.

At the 28 February 2005 VA Compensation and Pension (C&P) general examination, 3 months before separation, physical examination showed a normal gait without any assistive device and no peripheral edema (swelling). A focused right or left knee examination was not provided; however, the examiner recorded a “normal general physical examination.” At the VA C&P joints examination the next day,, physical examination showed three well-healed arthroscopic incisions of the right knee. There was no bilateral knee swelling, fluid, heat, erythema, or tenderness. There was moderate right knee and mild left knee crepitus during flexion and extension. There was no bilateral subluxation, contracture, laxity, instability, or evidence of a meniscal tear. Bilateral knee flexion was 140 degrees and extension was 0. Painful motion was not addressed.

The 10 March 2005 MEB NARSUM addendum performed by a rheumatologist, approximately 3 months prior to separation, addressed the CI’s right knee medical history and right knee osteoarthritis diagnosis. A specific right or left knee physical examination was not noted; however, the gait was normal, and there was “full” large and small joint ROM. Painful motion of the knees was not addressed.

The panel directed attention to its rating recommendation based on the above evidence. The PEB and VA rated both knee conditions 10% each, both analogously coded 5099-5003 (degenerative arthritis). The VA based the rating on the C&P joints examination, citing painful motion of a major joint.

The panel first addressed the right knee condition and agreed that 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 satisfactory STR evidence of right knee painful motion with functional loss to support a 10% rating (based on §§4.59, 4.40 and 4.45). There was no evidence of dislocated meniscus or loss body causing frequent locking with recurrent effusions (5258), but there was a history of arthroscopic surgery to remove an osteochondral defect with a chondroplasty (cartilage removal) of the lateral femoral condyle (5259) to warrant a 10% rating,

which offers no additional benefit to the CI. There was no fracture, nonunion or malunion of the femur or tibia causing a knee impairment (5255, 5262) to support a higher rating for the right knee under those codes. 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.

The panel then addressed the left knee condition and agreed that 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 evidence of dislocated meniscus or loss body causing frequent locking with recurrent effusions (5258), or a history of meniscal surgery (5259) despite the presence on an MRI of an osteochondral defect of the lateral femoral condyle (5259). There was no fracture, nonunion or malunion of the femur or tibia causing a knee impairment (5255, 5262) to support a higher rating for the right knee under those codes nor was there was satisfactory STR evidence of right knee painful motion with functional loss to support a 10% rating (based on
§§4.59, 4.40 and 4.45) under code 5003. 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 right knee condition and IAW VASRD §4.71a, the panel recommends no change in the PEB adjudication. 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.

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) PDBR ltr <ltd 23 May 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.

Copy to: PDBR