RECORD OF PROCEEDINGS PHYSICAL DISABILITY BOARD OF REVIEW
NAME:  XXXXXXXXXXXXXXXXXXXXX	CASE: PD-2017-04224
BRANCH OF SERVICE: NAVY	SEPARATION DATE: 20050812

SUMMARY OF CASE: Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E5 , Aviation Structural Mechanic, medically separated for “stable right knee examination with loss of flexion and extension” with a disability rating of 20%.

CI CONTENTION: Review requested of the knee condition, which has worsened and caused additional health issues.  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 - 20050429	VARD - 20051012	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Stable Right Knee ... Loss of Flexion and Extension	5261	20%	Degenerative Arthritis, Right Knee	5260	10%	20050624	
[Multiple Surgical Residuals] Right Knee	Cat II					
COMBINED RATING: 20%	COMBINED RATING OF ALL VA CONDITIONS: 30%	

ANALYSIS SUMMARY:

Right Knee Condition. According to the service treatment record (STR) and MEB narrative summary (NARSUM), the CI suffered a sports injury to her right knee that resulted in an anterior cruciate ligament reconstruction and meniscal repair in August 2004. This was followed by a final debridement and notchplasty in June 2004, after which satisfactory range of motion (ROM) was not achieved. Post-operative STR entries recorded flexion improving from 60 to 105 degrees (normal 140), and a significant limitation of extension from minus 5-10 degrees worsening to

minus 20-28 degrees (normal 0). An orthopedic entry on 7 October 2004 noted poor compliance with physical therapy and the CI was counseled accordingly with ROM improving to 120 degrees flexion and minus 15 degrees extension noted after full engagement in rehabilitation.

The 28 March 2005 MEB NARSUM, 5 months prior to separation, documented that the CI “remains with a low level of discomfort” that rendered her unable to run and limited prolonged standing, climbing, and bending. The physical examination recorded “no significant tenderness,” effusion, instability (“trace Lachman”), or impingement. Measured ROM was flexion to 120 degrees with a persistent 15-degree deficit in extension.

The 24 June 2005 VA Compensation and Pension (C&P) examination, 2 months before separation, noted constant, nonspecific pain and swelling that resulted in an “inability to kneel, climb stairs or ladders, run or stand for prolonged periods.” The physical examination recorded a normal gait, crepitus without effusion or tenderness, and no instability or impingement. Right knee ROM was normal, with pain onset at 0 degrees and worsened by repetition (no note of ROM loss).

The panel directed attention to its rating recommendation based on the above evidence. The PEB rated the right knee condition 20%, coded 5261 (limitation of extension). Additionally “status-post right knee ACL reconstruction, medial meniscus repair and subsequent debridement and notchplasty” was adjudicated as an associated Category II condition (contributing to the unfitting condition but not separately ratable). Members agreed that the latter was intrinsic to the rated condition such that a separate rating could not be supported without violation of VASRD §4.14 (avoidance of pyramiding), and was thus appropriately subsumed in the same rating. The VA rated the right knee condition 10%, coded 5260 (limitation of leg flexion), citing crepitus, tender scars and additional limitation of motion with repetition (the latter not corroborated by the C&P examiner). Panel members agreed that the PEB’s 20% rating was consistent with the applicable criterion of code 5261 for extension limited to 15 degrees. There was no fracture, nonunion or malunion of the femur or tibia to support consideration under the respective codes for knee impairment related to long bone conditions (5255, 5262), and no other applicable code available in VASRD §4.71a that would yield a rating higher than 20%. 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:

PD-2017-04224

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) PDBRltr

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.