RECORD OF PROCEEDINGS PHYSICAL DISABILITY BOARD OF REVIEW
NAME:	CASE: PD-2017-03302
BRANCH OF SERVICE:  NAVY	SEPARATION DATE: 20051021

SUMMARY OF CASE: Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E5, C130T Second Loadmaster, medically separated for “chondromalacia patella and osteochondral disease of the medial tibial plateau status post [S/P] anterior cruciate ligament [ACL] reconstruction” (left knee) with a disability rating of 20%.

CI CONTENTION: Review requested of the unfitting condition as well as additional conditions not identified by the Medical Evaluation Board (MEB) and/or 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 - 20050914	VARD - 20060223	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Left Knee Chondromalacia Patella and Osteochondral Disease ... S/P ACL Reconstruction	
5299-5003	
20%	[Surgical Residuals] with Limitation of Extension, Left Knee	5261	40%	20050928	
			[Surgical Residuals] Left Knee	5260	10%	20050928	
COMBINED RATING: 20%	COMBINED RATING OF ALL VA CONDITIONS: 80%	

ANALYSIS SUMMARY:

Left Knee Surgical Residuals. According to the service treatment record (STR) and MEB narrative summary (NARSUM), the CI underwent a meniscectomy and ACL reconstruction on his left knee in 1998. He suffered recurrent pain and swelling, and an MRI in 2003 revealed chondromalacia patella and significant (grade IV) chondromalacia without evidence of a meniscal tear or new ligamentous pathology. The damaged cartilage was surgically addressed by an arthroscopic chondroplasty in April 2004, but symptoms persisted and it was opined that no further surgical intervention was indicated at the time. Provider notes in the STR after the final surgery documented improving range of motion (ROM), and an entry in January 2005 recorded flexion to 80 degrees (normal 140) and extension to 0 degrees (normal). Treatment notes in April 2005 noted flexion to 120 and 125 degrees, both with 0 degrees extension. There was STR

documentation of the absence of persistent effusion or instability, and no indication of joint impingement (locking), with ample evidence of a normal gait.

The 7 June 2005 MEB NARSUM (orthopedist), less than 5 months prior to separation, recorded nonspecific left knee pain (no subjective instability or locking) that limited prolonged walking or standing and squatting. The physical examination made no note of gait disturbance and documented a trace effusion, tenderness, crepitus, and stability in all planes without impingement. Measured ROM revealed flexion to 120 degrees and minus 3 degrees of extension.

At the 28 September 20055 Compensation and Pension (C&P) examination by internal medicine, a month before separation, the CI reported constant left knee pain with frequent swelling and locking (no subjective instability) that limited prolonged walking or standing, running, kneeling, squatting and climbing stairs. The physical examination recorded a “slight” limp due to left knee pain, patellar tenderness and crepitus, but no effusion, instability, or note of impingement. Measured ROM showed flexion to 100 degrees and minus 20 degrees of extension, specifying pain at minus 40 degrees extension. The examiner opined that there was no ROM degradation with repetition without resorting to speculation.
The panel directed attention to its rating recommendation based on the above evidence. The PEB rated the left knee condition 20%, coded 5299-5003 (analogous to degenerative arthritis [correct prefix is 5099]). The VA conferred two ratings for the left knee as charted above, based on the C&P examination. A rating of 40% was granted under code 5261 (limitation of extension), conceding pain at minus 40 degrees (per C&P examiner) as a ratable criterion. Code 5261 specifies a 30% rating for extension limited to minus 20 degrees (the full measured ROM by the VA examiner) and 40% for extension limited from minus 30 to 44 degrees. It specifies a 0% rating for extension limited to minus 5 degrees or less. The VA provided an additional rating of 10% under code 5260 (limitation of flexion), citing painful motion. Code 5260 specifies a 0% rating for flexion to 60 degrees or more.

The panel first noted that, although dual ratings for limitation of flexion and limitation of extension as granted by the VA in this case were permitted by VA guidance in effect, the latter stipulated that both flexion and extension must be limited to the minimum 10% threshold. It specified that painful motion was not applicable in this circumstance, and panel members accordingly opined that dual ratings as above were not authorized. Nevertheless, alternative (not additional) rating under code 5261 was considered based on the C&P evidence for limitation of extension. The panel agreed, however, that the latter was not sufficiently probative as the sole basis for the panel’s recommendation. Although it was the most temporally probative evidence for measured extension, it was contrary, and inexplicably so, to all of the service evidence. The latter was well corroborated by multiple specialty examiners, and thus panel members agreed that a higher rating under code 5261 was not justified. The panel considered other VASRD knee and analogous codes, but all were less applicable and/or not advantageous for rating. There were no other criteria in evidence to support a rating higher than 20% under any applicable VASRD §4.71a code. After due deliberation, considering all the evidence and mindful of VASRD §4.3 (reasonable doubt), the panel concluded that 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 that there be 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 TIIB NAVY COUNCIL OF REVIEW BOARDS 720 KENNON STREET SE STE 309
WASHINGTON NAVY YARD, DC 20374-5023

IN REPLY REFER TO :
1850
CORB: 003
10 Sep 20

From: Director, Secretary of the Navy Council of Review Boards To:

Subj: PHYSICAL DISABILITY BOARD OF REVIE_W (PDBR) Ref:	(a) DoDI 6040.44
1.	Pursuant to reference (a), the PDBR reviewed your case and forwarded its recommendation to the Department of the Navy on 13 Aug 2020 for appropriate action.

2.	On 27 August 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.