RECORD OF PROCEEDINGS PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXX		CASE: PD-2017-03537 BRANCH OF SERVICE: NAVY	SEPARATION DATE: 20090429

SUMMARY OF CASE: Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E4, Culinary Specialist, medically separated for “internal derangement of knee medial meniscus status post left medial meniscectomy” with a disability rating of 10%.

CI CONTENTION: “My knee and back and GERD give me problems every day and make it difficult to keep a job.”  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 - 20090126	VARD - 20090616	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Internal Derangement of Knee Medial Meniscus…	5099-5003	10%	Medical Collateral Ligament Tear with Arthritis, Left Knee	5010-52604	20%	20090616	
Patellar Tendinitis	Category II					
COMBINED RATING: 10%	COMBINED RATING OF ALL VA CONDITIONS: 20%	

ANALYSIS SUMMARY:

Internal Derangement of Left Knee Medial Meniscus. According to the service treatment record and MEB narrative summary (NARSUM), the CI’s left knee condition began in July 2007 after accidentally falling down some stairs. He CI subsequently underwent left knee arthroscopic surgery to debride a medial meniscal tear and cut a medial plica band in March 2008. Intermittent left knee pain continued, and in June 2008, he reported severe pain and mild to

moderate swelling after pivoting on the knee, which gave out. Knee X-rays on 23 June 2008 were normal, but an MRI showed a small oblique tear of the posterior horn of the medial meniscus, (unchanged from a prior study), and a small Baker’s cyst. On 29 July 2008, left knee range of motion (ROM) was 0-105 degrees (normal 0-140) with pain at the extreme of flexion during passive motion. In October 2008, he reported continued anterior and lateral knee pain, which was felt to be a very mild patellar tendinosis and a tight iliotibial band. No further surgical intervention was recommended.

During the 24 November 2008 MEB NARSUM examination, 5 months prior to separation, the CI reported left knee pain, and the examiner noted left patellar tendon and iliotibial band tenderness. Left knee flexion was “approximately” to 120 degrees and extension to 0 degrees (normal), with painful motion. There was no instability, laxity, or specific joint line tenderness. The MEB NARSUM addendum examination the next day, noted CI complaints of continued daily left knee pain and difficulty with stairs or ladders. Physical examination showed a normal gait and painful meniscal impairment testing; left knee flexion lacked 30 degrees (approximately 110 degrees) compared to the right, and extension was full; painful motion was not addressed.

At the 14 April 2009 VA Compensation and Pension (C&P) examination, 2 weeks before separation, the CI reported daily, sharp, burning, and throbbing left knee pain that occasionally radiated into the left calf. The left knee was chronically swollen and gave out twice a week, but did not lock up. The examiner noted a normal gait and “exquisite pain” with light palpation of the medial aspect of the left knee joint. There was crepitus but no instability, and meniscal impairment testing was not possible due to pain. Left knee flexion was to 80 degrees and extension to 0 degrees, with painful motion. Following repetition, there was a loss of 10 degrees of flexion due to pain, weakness, fatigue, and lack of endurance and coordination.

The panel directed attention to its rating recommendation based on the above evidence. The PEB rated the left knee condition 10%, analogously coded 5099-5003 (degenerative arthritis). The PEB listed patellar tendinitis condition as a related diagnosis (Category II) contributing to the disability in this case, but the panel concluded that it was not a separate condition which could be reasonably justified as separately unfitting; nor would a separate rating be achievable without violation of VASRD §4.14 (avoidance of pyramiding). The VA rated the left knee condition 20%, dual coded 5010-5260 (arthritis due to trauma-leg, limitation of flexion), based on the C&P examination, citing the DeLuca factor showed left knee limitation of motion and increased disability due to weakness, excess fatigability, incoordination, or painful motion. Panel members agreed that there was no limitation of flexion or extension (5260 or 5261) to support a compensable rating. However, there was evidence of painful motion with functional loss to support a 10% rating based on VASRD §4.59, §4.40 and §4.45. There was no evidence of a dislocated meniscus or loss body causing frequent locking with recurrent effusions (5258), or fracture, nonunion or malunion of the femur or tibia causing a knee impairment (5255, 5262) to support ratings under those codes. There was a history of meniscal surgery with a symptomatic left knee (5259) which alternatively warranted a 10% rating, but offered no additional benefit to the CI. 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.

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 28 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.