RECORD OF PROCEEDINGS PHYSICAL DISABILITY BOARD OF REVIEW
NAME:  XXXXXXXXXXXXXXX	CASE: PD-2017-04189
BRANCH OF SERVICE: NAVY	SEPARATION DATE: 20080312

SUMMARY OF CASE: Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E6, Career Recruiter, medically separated for “right knee osteoarthritis” with a disability rating of 10%.

CI CONTENTION: Review requested of additional conditions not identified by the Medical Evaluation Board (MEB) and Physical Evaluation Board (PEB) was 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 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 - 20071129	VARD - 20080929	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Right Knee Osteoarthritis	5099-5003	10%	

Post Right Knee ACL Reconstruction	

5014	

10%	

20080520	
Status Post (S/P) Lateral Meniscectomy and Medial Meniscus Repair	

Cat II					
S/P Anterior Cruciate Ligament (ACL) Reconstruction						
S/P Right Patella Tendon Reconstruction and Quadricepsplasty						
Chronic Renal Failure, Stage I	Cat III	Renal Failure with Hypertension	7541	60%	20080520	
Essential Hypertension	Cat III					
Obstructive Sleep Apnea	Cat III	Obstructive Sleep Apnea	6847	50%	20080520	
Chronic Exogenous Obesity	Cat IV	No VA Placement	
COMBINED RATING: 10%	COMBINED RATING OF ALL VA CONDITIONS: 90%	

ANALYSIS SUMMARY:

Right Knee Osteoarthritis. According to the service treatment record (STR) and MEB narrative summary (NARSUM), the CI underwent a right knee arthroscopic ACL reconstruction surgery in March 1996. In May 1997, he additionally had an arthroscopic medial meniscal repair, partial lateral meniscectomy, partial ACL debridement and osteochondral debridement. He underwent a final right knee surgery in August 2006 for patella tendon reconstruction with hamstring allograft for a ruptured patella tendon. At an orthopedic visit on 16 February 2007, he reported chronic right knee pain. On examination, the right knee was stable medially and laterally with no

swelling and negative McMurray’s and Lachman tests (for meniscal signs and laxity respectively). Right knee range of motion (ROM) showed flexion of 130 degrees (normal 140) and extension of 0 degrees (normal).  Crepitus was present with palpable osteophytes.

The 5 July 2007 MEB NARSUM examination, 8 months prior to separation, noted complaints of right knee pain but minimal discomfort with activities of daily living as long as he limited walking. Physical examination showed a normal gait and a benign-appearing anterior longitudinal incision. Measured right knee ROM revealed flexion of 120 degrees and extension of 0 degrees. The right knee was stable medially and laterally and a Lachman’s test was normal. There was no knee swelling and distal neurovascular findings were normal. An X-ray demonstrated osteophytes with tri-compartment degenerative changes and hardware in place.

At the 20 May 2008 VA Compensation and Pension (C&P) examination, 2 months after separation, the CI reported recurrent right knee swelling, with no catching or locking, but some giving way and frequent popping. He had occasional flare-ups but no incapacitating episodes in the past year. Physical examination showed multiple well-healed scars and a somewhat enlarged knee joint without any swelling. McMurray’s, Lachman’s, drawer, and pivot tests were negative, but there was pseudo-laxity of the medial collateral ligament. Lateral ligaments were intact with some medial joint knee pain but no joint line tenderness. Right knee ROM measurements showed flexion of 100 degrees and extension of 5 degrees, with painful motion at the endpoints, but no increased pain, fatigue, or incoordination during repetition. An X-ray showed joint space narrowing and osteophyte formation but no anterior translation of the tibia.

The panel directed attention to its rating recommendation based on the above evidence. The PEB rated the right knee condition 10%, analogously coded 5003 (arthritis, degenerative). The PEB also listed S/P lateral meniscectomy and medial meniscus repair, S/P ACL reconstruction and S/P right patella tendon reconstruction, and quadricepsplasty as related Category II conditions (contributed to the primary unfitting condition but not separately ratable). Panel members agreed that the impairment from the Category II diagnoses were properly subsumed under the overall rating for the right knee osteoarthritis IAW §4.14 (avoidance of pyramiding; more than one rating based on the same impairment is prohibited). The VA also rated the right knee condition 10%, but coded 5014 (osteomalacia), based on the C&P examination, citing painful or limited motion of a major joint shown by abnormal extension and flexion. The panel agreed that while there was no compensable limitation of flexion or extension (5260 or 5261), there was evidence of painful motion with functional loss supporting a 10% rating (based on §4.59, §4.40 and §4.45). Code 5259 (cartilage, semilunar, removal of, symptomatic) was also applicable in this case and provided an alternate route to a 10% rating. Panel members considered other VASRD knee and analogous codes, but all were less applicable and/or not advantageous for rating. 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.

Contended PEB Conditions: Chronic Renal Failure, Essential Hypertension, Obstructive Sleep Apnea (OSA) and Chronic Exogenous Obesity. The panel’s main charge is to assess the fairness of the PEB determination that the contended conditions were not unfitting. None of the conditions were noted on limited duty forms. Only obesity does not constitute a physical disability, and was correctly designated as Category IV by the PEB. There was no performance- based evidence from the record that any of the Category III conditions significantly interfered with satisfactory duty performance at separation. After due deliberation, the panel concluded there was insufficient cause to recommend a change in the PEB fitness determination for any of the contended conditions, so no additional disability ratings are recommended.

BOARD FINDINGS: In the matter of the right knee condition and IAW VASRD §4.71a, the panel recommends no change in the PEB adjudication. In the matter of the contended chronic renal failure, essential hypertension, obstructive sleep apnea and chronic exogenous obesity, the panel recommends no change from the PEB determinations as not unfitting. 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

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 19 Nov 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.