From: To:

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

IN   REPLY   REFER  TO:
1850
CORB:003
20 Feb 20

Director, Secretary of the Navy Council of Review Boards 
PD-2017-04142

Subj:	PHYSICAL DISABILITY BOARD OF REVIEW (PDBR)

Ref:	(a) DoDI 6040.44
(b) PDBR ltr dtd 11 Mar 19

1.	Pursuant to reference (a), the PDBR reviewed your case and forwarded its recommendation (reference (b)) to the Department of the Navy.

2.	On 12 February 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.

RECORD OF PROCEEDINGS PHYSICAL DISABILITY BOARD OF REVIEW
NAME:  XXXXXXXXXXXXXXXXXX	CASE: PD-2017-04142
BRANCH OF SERVICE: NAVY	SEPARATION DATE: 20081217

SUMMARY OF CASE: Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E5, Religious Programs Specialist, medically separated for “patellofemoral mal-tracking [right knee]” with a disability rating of 10%.

CI CONTENTION: “More surgeries, multiple issues all documented in VA records.” 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 - 20080902	VARD - 20090402	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Patellofemoral Mal-Tracking, Right	5099-5003	10%	Degenerative Arthritis of Multiple Joints to Include: Right Knee and Left Knee	
5003	
10%	
20080911	
Right Anterior Knee Pain	Cat II					
Genu Valgum	Cat II					
COMBINED RATING: 10%	COMBINED RATING OF ALL VA CONDITIONS: 20%	
	
ANALYSIS SUMMARY:

Patellofemoral Mal-Tracking, Right Knee. According to the service treatment record (STR) and MEB narrative summary (NARSUM), the CI underwent a right knee surgery with diagnostic arthroscopy and lateral retinacula release in February 2008. The CI tolerated the procedure well, however, the postoperative course was complicated by hemarthrosis, resulting in excessive knee swelling and stiffness. Ultimately, the swelling resolved and the CI regained significant motion. In spite of her complete recovery from the surgical procedure, she continued to have significant and increasingly disabling symptoms of right anterior knee pain. It was determined her condition

was related to chronic arthritic changes in the right knee, but she was not a candidate for additional surgical intervention.

The 24 July 2008 MEB NARSUM examination, 5 months prior to separation, noted complaints of persistent and intermittently disabling symptoms of right knee pain and swelling which limited her recreational and daily living activities. Physical examination showed a non-antalgic gait. There was no warmth, effusion, erythema or sign of infection. Flexion was 140 degrees (normal) and extension was 0 degrees (normal). There was excellent stability to anterior and posterior and varus and valgus stresses. Although patella tracking was normal, there was significant discomfort with mobilization of the patella and with patellar compression, particularly over the lateral facet, with mild crepitus and discomfort with palpation along the lateral peri-patellar retinaculum.

At the 11 September 2008 VA Compensation and Pension (C&P) examination, 3 months before separation, the CI reported right knee problems and discomfort with running and playing sports, and marked knee pain with squatting, climbing, walking and turning. She also reported swelling with almost any strain of her right knee or with vigorous activity. Physical examination showed normal gait and posture. Range of motion (ROM) testing showed flexion of 140 degrees and extension of 0 degrees. She had a negative McMurray's, Lachman’s, and anterior drawer tests. There was 2/4 crepitus and some discomfort and pressure on the right joint line.

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 (arthritis, degenerative). The Navy PEB listed “right anterior knee pain” and “genu valgum” as related diagnoses (Category
II) that contributed to the disability in this case. The panel agreed these conditions were diagnoses related to the Category I unfitting condition and were not separate conditions which could be separately rated without pyramiding (§4.14). The VA also rated the right knee condition 10%, coded 5003 (arthritis, degenerative), based on the STR and C&P examination, citing MRI findings of osteoarthritis without painful or limited motion, or incapacitating exacerbations.

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 evidence of painful motion, crepitus, and tenderness 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) or history of surgery to remove a meniscus (5259) to support a rating under those codes. There was no fracture, nonunion or mal-union 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 right 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. 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: