RECORD OF PROCEEDINGS PHYSICAL DISABILITY BOARD OF REVIEW
NAME: XXXXXXXXXXXXXXXXXXXXXXX	CASE: PD-2017-05223
BRANCH OF SERVICE: NAVY	SEPARATION DATE: 20061023

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

CI CONTENTION: “Review all conditions.” 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 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 – 20060505	VARD – 20070307	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Bilateral Knee Pain	5299-
5003	10%	Patellofemoral Syndrome, Left Knee	5260	0%	20060703	
			Patellofemoral Syndrome, Right Knee	5260	0%	20060703	
Functional Dyspepsia	Cat III	
GERD with Irritable Bowel Syndrome	7346-
7319	
10%	
20060703	
GERD	Cat III					
Irritable Bowel Syndrome	Cat III					
Narcolepsy, Mild	Cat III	Narcolepsy	8018	10%	20060703	
Depressive Disorder	Cat III	Panic Disorder	9412	30%	20060628	
Bilateral Carpal Tunnel Syndrome	Cat III	Left Carpal Tunnel Syndrome	8515	10%	20060703	
		Right Carpal Tunnel Syndrome	8515	10%	20060703	
COMBINED RATING: 10%	COMBINED RATING OF ALL VA CONDITIONS: 80%	

ANALYSIS SUMMARY:

Chronic Bilateral Knee Pain. According to the service treatment record (STR) and MEB narrative summary (NARSUM), the CI’s bilateral knee condition started on or around 2004. There was no noted trauma or injury to the knees. There was bilateral knee pain without swelling and significant symptoms persisted despite therapy. X-rays of the knees were normal. The August 2005 knee MRIs revealed a left knee medial meniscus tear and possible right knee focal peripheral meniscus tear. Orthopedics advised no surgery, but recommended an MEB.

The 22 February 2006 MEB NARSUM examination, 8 months prior to separation, noted complaints of constant bilateral knee pain which worsened with use of stairs, squatting or

kneeling. Physical examination of both knees revealed normal alignment, no effusions and “normal full” range of motion (ROM) with flexion to 145 degrees (normal 140). Patellofemoral tracking was normal. There was no localized tenderness. McMurray test (for meniscal pathology) on the right caused discomfort, but no popping, when the medial and posteromedial joint were compressed. Patellofemoral tracking was normal and there was no quadriceps atrophy.

At the 3 July 2006 VA Compensation and Pension (C&P) examination, 3 months before separation, the CI reported chronic knee pain, right more than left. Physical examination of both knees showed crepitus of each knee. There was left medial joint line tenderness and right medial and lateral joint line tenderness (meniscal sign). Each knee demonstrated full ROM from 0 degrees extension to 145 degrees flexion (normal 0-140 degrees) with pain noted at 145 degrees. There was no evidence showing laxity or instability of either knee. X-ray analysis did not show any joint abnormality, such as arthritis.

The panel directed attention to its rating recommendation based on the above evidence. The PEB rated the bilateral knee condition 10%, analogously coded 5299-5003 (degenerative arthritis). The VA rated the left and right knee 0% each for a combined 0% rating, each analogously coded 5260 (leg, limitation of flexion), based on the C&P examination, citing left and right knee flexion limited to 60 degrees.

The panel first considered whether each knee condition, having been de-coupled from the combined PEB adjudication, remained separately unfitting as established above. The NARSUM implicated both knees as having bilateral patellofemoral syndrome and failing retention standards. The panel concluded there was not a preponderance of evidence in the STR which overcame the panel’s presumption that the unbundled left and right knees were reasonably considered separately unfitting. The panel then considered its rating recommendation.

The C&P examination indicated mild crepitus and pain noted at ROMs only beyond the VASRD normal flexion limit of 140 degrees. The MEB evaluation documented no pain-limited motion. Panel members agreed that there was insufficient evidence to support painful motion of both knees to support a combined rating higher than the 10% adjudicated by the PEB. The panel considered alternative VASRD knee and analogous codes, but all were less applicable and/or not advantageous to 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 bilateral knee condition.

Contended PEB Conditions: Functional Dyspepsia; GERD; Irritable Bowel Syndrome (IBS); Narcolepsy, Mild; Depressive Disorder, and Bilateral Carpal Tunnel Syndrome. 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 (LIMDU) forms, implicated in the non-medical assessment (NMA), or forwarded on the NAVMED 6100/1. There was a second LIMDU for the mental health (MH) condition of specific phobia situational and panic disorder without agoraphobia, and the 24 April 2006 psychiatric addendum to the NARSUM detailed the MH treatment history and continued fitness for duty, as well as the recent additional diagnosis of depressive disorder not otherwise specified which was not considered to be disabling. The NMA had indicated the CI performed admirably. There was no performance-based evidence from the record that any of the 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 bilateral knee condition and IAW VASRD §4.71a, the panel recommends no change in the PEB adjudication. In the matter of the contended dyspepsia, GERD, irritable bowel syndrome, narcolepsy, depressive disorder, and bilateral carpal tunnel syndrome, 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 TI!E NAVY COUNCIL OF REVIEW BOARDS
72 0 KENNON STREET SE STE 309 WASHINGTON NAVY YARD, DC 20374-5023

Ill REPLY REFER TO,
1850
CORB: 003
10 Sep20

From: Director, Secretary of the Navy Council of Review Boards To:	

Subj: PHYSICAL DISABILITY BOARD OF REVIEW (PDBR) Ref:	(a) DoDI 6040.44
1.	Pursuant to reference (a), the PDBR reviewed your case and forwarded its recommendation to the Department of the Navy on 13 Aug 2020 for appropriate action.

2.	On 27 August 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.