RECORD OF PROCEEDINGS PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXX		CASE: PD-2017-03595 BRANCH OF SERVICE: NAVY	SEPARATION DATE: 20080407

SUMMARY OF CASE: Data extracted from the available evidence of record reflects this covered individual (CI) was an E4, Master-at-Arms, medically separated for “[right knee] osteoarthritis” with a disability rating of 10%.

CI CONTENTION:  Review of all conditions requested. 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 - 20080225	VARD - 20080429	
Condition	Code	Rating	Condition	Code	Rating	Exam	
[Right Knee] Osteoarthritis	5099-5003	10%	
S/P Right Knee Surgeries	
5299-5260	
10%	
20070802	
Persistent Muscular Atrophy and Knee Pain	Cat II					
Greater Than 1 Year S/P Primary Repair of Right Traumatic Patellar Tendon Disruption	Cat II					
COMBINED RATING: 10%	COMBINED RATING OF ALL VA CONDITIONS: 40%	

ANALYSIS SUMMARY:

Osteoarthritis. According to the service treatment record and MEB NARSUM the CI underwent two right knee surgeries: a repair of a torn (avulsed) patellar tendon in January 2005; surgery in March 2007 revealed extensive medial patellar facet chondromalacia and included partial synovectomy and debridement. Despite continued physical therapy, light duty, and activity modification the right knee pain did not subside. The 16 May 2007 MEB NARSUM examination, 11 months prior to separation, noted right anterior knee pain. Physical examination showed an antalgic gait. There was trace right lower extremity effusion and trace quadriceps atrophy. Right

knee flexion was 130 degrees (normal 140) with exacerbating pain and moderate patellofemoral crepitus. Extension was 0 degrees (normal). There was discomfort during patellar compression testing. There was no apprehension with medial or lateral patella displacement and knee range of motion (ROM).

At the 2 August 2007 VA Compensation and Pension (C&P) examination, 8 months before separation, the CI reported bilateral knee pain, instability, and use of knee braces. Physical examination showed moderate right knee effusion and slight warmth. Meniscal impairment sign testing was negative. Right knee flexion was 130 degrees and extension was 0 degrees. There was no ROM loss following repetitive motion, but increased painful motion was elicited.   The    5 September 2007 MEB NARSUM addendum also noted right anterior knee pain. Physical examination revealed a nonantalgic gait, trace right knee effusion and fullness and no significant tenderness. Patellar tracking (movement) was unremarkable, and knee extension was “full.” Painful motion and flexion were not addressed. Right quadriceps strength was 5/5.

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 (degenerative arthritis). The PEB listed persistent muscular atrophy and knee pain, and “greater than 1 year status post (s/p) primary repair of right traumatic patellar tendon disruption” as related diagnoses (Category
II)	contributing to the disability in this case. The PEB’s Category II diagnoses are intrinsic to the rated condition and separate ratings cannot be supported without pyramiding (VASRD §4.14); thus, they are appropriately subsumed under the same rating. The VA rated the right knee condition 10%, analogously coded 5299-5260 (leg, limitation of flexion), based on the C&P examination, citing painful motion.

The panel agreed 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 evidence of painful motion with functional loss supporting a 10% rating (based on
§§4.59, 4.40 and 4.45), as reported on MEB NARSUM and VA ROM examinations. There was no evidence of dislocated meniscus or loose 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 a higher rating 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.

BOARD FINDINGS: In the matter of the osteoarthritis 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.

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2	PD-2017-03595

DEPARTMENT OF THE NAVY
SECRETARY OF THE NAVY COUNCIL OF REVIEW BOARDS 720 KENNON STREET SE STE 309
WASHINGTON NAVY YARD, DC 20374-5023

Ht    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 17 Jun 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.