RECORD OF PROCEEDINGS PHYSICAL DISABILITY BOARD OF REVIEW
NAME:  XXXXXXXXXXXXXXXX	CASE: PD-2017-04298
BRANCH OF SERVICE: NAVY	SEPARATION DATE: 20070815

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

CI CONTENTION:  No specific contention was made.  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 - 20070531	VARD - 20070913	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Osteoarthritis Right Knee	5099-5003	10%	Status Post Meniscal Surgery (Right Knee)	5299-5260	10%	20070627	
Mechanical Low Back Pain due to Altered Gait from Right Knee Pain	Cat II	Lumbosacral Strain	5237	0%	20070627	
Hip Pain Likely Secondary to Abnormal Gait (Right Knee Pain)	Cat II	Right Hip Strain	5299-5252	0%	20070627	
COMBINED RATING: 10%	COMBINED RATING OF ALL VA CONDITIONS: 10%	
	
ANALYSIS SUMMARY:

Right Knee. According to the service treatment record (STR) and MEB narrative summary (NARSUM), the CI had longstanding right knee pain which started in 2004. During an arthroscopy on 3 May 2004, a medial plica (fold of synovial joint lining), tear of the posterior medial meniscus, and chondromalacia of the medial femoral condyle were identified and all repaired. A partial tear of the anterior cruciate ligament was also noted, but he did not have any instability symptoms.

At an orthopedic examination on 3 October 2006, the CI reported 6 months of chronic right knee pain aggravated by stairs, ladders, squats, and running; he also described low back pain “sometimes” for the previous 3 days. The provider noted medial joint line tenderness and positive testing for meniscal pathology, but no evidence of instability or patellar crepitus. Range of motion (ROM) was full with painful motion. Knee X-rays were normal, but an MRI showed chondromalacia of the medial femoral condyle and patella, and the CI was diagnosed with bursitis (pes anserine bursitis). At a physical therapy visit on 12 February 2007, he had no knee pain. Physical examination showed a normal gait, full strength, good patellar tracking and no swelling, apprehension or crepitus with “no limitations noted.” The CI reported low back discomfort and was referred to his primary care physician. Lumbar spine X-rays on 28 February 2006 were negative, and in April 2007, the CI declined a diagnostic arthroscopy.

The 24 April 2007 MEB NARSUM examination, 4 months prior to separation, noted complaints of persistent right knee pain, some low back pain, and new right hip pain. The examiner documented diffuse tenderness of the medial aspect of the knee, but no patellar compression or evidence of instability. Measured ROM showed right knee flexion to 155 degrees (normal 140) and extension to 0 degrees (normal), with pain during resisted flexion and testing for meniscal pathology, but no catching. Hip flexion was to 110 degrees (normal 125), internal rotation to 45 degrees (normal 40), and external rotation to 20 degrees (normal 60). A resisted leg raise caused pain in the hip region. Right knee X-rays from the fall of 2006 showed mild degenerative changes associated with meniscectomy and the CI declined a diagnostic arthroscopy. During the MEB examination (recorded on DD Forms 2807-1 and 2808) the next day, the CI reported right knee pain, giving out, and locking as well as recurrent low back pain. Physical examination showed right knee flexion to 120 degrees and normal extension, with pain. There was medial joint line pain and testing for meniscal injury was positive medially.

At the 27 June 2007 VA Compensation and Pension (C&P) examination, 2 months before separation, the CI described medial knee pain of variable intensity which he treated with anti- inflammatory medication and/or glucosamine as needed. He occasionally wore a knee brace in the morning but not consistently. He reported that due to an altered gait from the right knee pain, he had developed right hip pain, but it did not interfere with daily activities or work. He also had a history of low back pain since 2001, exacerbated by the right knee pain, and needed to sit or rest after flare ups which occurred about 3 times a week. Repetitive use did not cause back pain, and he denied any restrictions or incapacitation in the previous 12 months or need for medication to relieve symptoms. Physical examination showed a normal gait and posture, and no knee swelling, tenderness, or instability. Knee ROM was from 0-140 degrees, with painful motion, and back ROM was full, without pain. Hip ROM was near normal without pain, and there was no pain, weakness, fatigability or lack of endurance with repetitive use of the hip or back.

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 VA also rated the right knee condition 10%, but analogously coded 5299-5260 (leg, limitation of flexion), based on the C&P examination, citing flexion from 0-140 degrees, with complaints of pain with repetitive movement and negative X-rays. While there was no compensable limitation of flexion or extension (5260 or 5261), there was evidence of painful motion with functional loss to support a 10% rating (based on §4.59, §4.40 and §4.45). There was also no history or evidence of dislocated meniscus or loose body causing frequent locking with recurrent effusions (5258); or 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). Although code 5259 (cartilage, semilunar, removal of, symptomatic) was applicable, the maximum available 10% rating provided no benefit to the CI. There was therefore no rating higher than a 10% under any applicable VASRD 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.

Contended Conditions: Mechanical Low Back Pain and Hip Pain Likely Due to Abnormal Gait from Right Knee Pain: The panel’s first charge for these Category II (contribute to the unfitting condition but not separately ratable) conditions was to assess whether either of them could be reasonably justified as separately unfitting for rating consideration. The lower back and hip conditions were not noted on limited duty forms (which only addressed the right knee), or implicated in the non-medical assessment. After a thorough review of the available evidence, the panel concluded that a preponderance of evidence indicates both conditions were not justified as separately unfitting. After due deliberation, the panel concluded that there was insufficient cause to recommend a change in the PEB adjudications for the low back and hip conditions, and therefore no additional 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 back and hip conditions, the panel recommends no change from the PEB adjudications. 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

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) PDBRltrdtd 12 Sep 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.