RECORD OF PROCEEDINGS PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXXXXXXX		CASE: PD-2017-03179 BRANCH OF SERVICE: MARINE CORPS	SEPARATION DATE: 20090327

SUMMARY OF CASE: Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty O2, Air Defense Control Officer, medically separated for “tricompartmental osteoarthritis of the left knee” with a disability rating of 10%.

CI CONTENTION: Review requested of the left knee as well as additional conditions not identified by the Medical Evaluation Board (MEB) and Physical Evaluation Board (PEB). 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 - 20081027	VARD - 20090624	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Tricompartmental Osteoarthritis of the Left Knee Surgically Treated	5099-
5003	10%	
Status Post Left Knee Arthroscopy and Reconstructive Surgery…	

5260	

10%	

20081204	
Old Disruption of the Anterior Cruciate Ligament, Left Knee	Cat II					
COMBINED RATING: 10%	COMBINED RATING OF ALL VA CONDITIONS: 70%	

ANALYSIS SUMMARY:

Left Knee Tricompartmental Osteoarthritis. According to the service treatment record (STR) and the MEB narrative summary (NARSUM), the CI underwent left knee surgery in September 2006 to repair a torn anterior cruciate ligament (ACL) with a hamstring autograft. An MRI on 7 June 2007 showed the ACL repair within normal limits, an essentially absent medial meniscus (indicating a tear), an articulating cartilage defect of the lateral femoral condyle, and a moderate knee joint effusion. In September 2007, he underwent a left knee diagnostic arthroscopy, which revealed tricompartmental chondromalacia grades 2 through 4, and a microfracture procedure was performed. Postoperatively, he reported left knee pain, locking, instability, and giving way  if he ran more than 50 yards or walked more than 1.5 miles.

The 2 September 2008 MEB NARSUM examination, 7 months before separation, noted complaints significant left knee pain, locking, and giving way. He also experienced swelling and decreased ROM after any type of activity, such as walking more than a mile. Physical examination revealed medial and lateral joint line tenderness, but normal knee alignment and no varus/valgus or recurvatum deformity, or swelling. Left knee ROM showed active flexion of 90 degrees (normal 140) and extension of 0 degrees (normal). Strength was 5/5 and sensation was intact to light touch in all nerve distributions. Reflexes were 2+ and there was no laxity with varus or valgus stress at 0 or 30 degrees. Lachman’s testing revealed 2 mm of anterior translation of the tibia, which with a good endpoint, was equal to his unaffected knee. He had pain with McMurray’s testing, but there was no click, and he guarded with a pivot. Left knee X-rays revealed mild joint space narrowing, subchondral sclerosis (thickening), and osteophyte formation in all three compartments as well as condyle squaring. The examiner diagnosed tricompartmental osteoarthritis and an old disruption of the ACL with no evidence of residual instability after reconstruction. The examiner noted that because of the CI’s advanced osteoarthritis, he might be a candidate for a joint replacement, but because of his young age, and the physical demands of his job, it was not recommended at that time.

At the 4 December 2008 VA Compensation and Pension (C&P) examination, 4 months before separation, the CI reported he injured his knee 5 years earlier while making a parachute landing and underwent reconstructive surgery in 2006 and arthroscopic surgery in 2007. He complained of constant crushing, sharp left knee pain, rated at 8/10, that radiated up to the thigh. He also reported weakness, stiffness, swelling, heat, redness, giving way, lack of endurance, locking, fatigability, grinding, and popping. Physical examination showed weakness, tenderness, guarding of movement, significant crepitus, and mild quadriceps atrophy. Patellofemoral compression testing (to correlate anterior knee pain with articular degeneration) was positive bilaterally. Left knee ROM showed flexion of 90 degrees and extension of 0 degrees, with painful motion, but no further limitation with repetition. Ligament testing revealed no laxity or instability, and McMurray’s and drawer tests were normal bilaterally.

The panel directed attention to its rating recommendation based on the above evidence. The PEB rated the left knee condition 10%, analogously coded 5003 (arthritis, degenerative), and listed left knee ACL disruption as a related Category II (contributes to the primary unfitting condition but was not separately ratable) condition. Panel members agreed that the impairment from this diagnosis was properly subsumed under the overall rating for the left knee tricompartmental osteoarthritis IAW §4.14 (avoidance of pyramiding; more than one rating based on the same impairment is prohibited). The VA also rated the left knee condition 10%, but coded 5260 (leg, limitation of flexion of), based on the C&P examination, citing X-ray evidence of osteoarthritis and painful limitation of motion causing functional impairments. The panel noted that while there was no compensable limitation of flexion or extension (5260 o 5261), there was evidence of painful motion with functional loss supporting a 10% rating (based on §4.59, §4.40 and §4.45). There was no history or evidence of dislocated meniscus or loose body causing frequent locking with recurrent effusions (5258) and although an MRI indicated an absent medial meniscus, application of code 5259 (cartilage, semilunar, removal of, symptomatic) would warrant a maximum 10% rating, which would provide no additional benefit to the CI since pyramiding is to be avoided IAW VASRD §4.14. 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). 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 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.

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 dtd 23 Sep 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 ofno 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