RECORD OF PROCEEDINGS PHYSICAL DISABILITY BOARD OF REVIEW
NAME:  XXXXXXXXXXXXXXXXXXXXX	CASE: PD-2017-05792
BRANCH OF SERVICE: NAVY	SEPARATION DATE: 20090224

SUMMARY OF CASE: Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E6, Transmission System Technician, medically separated for “post-traumatic osteoarthritis of the left knee” with a disability rating of 10%.

CI CONTENTION: Review of all conditions 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 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 - 20081029	VARD - 20090918	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Post-Traumatic Osteoarthritis
of the Left Knee	5099-5003	10%	
Left Knee Osteoarthritis	
5010-5262	
10%	
20090717	
Left Knee Osteoarthritis S/P Tibial Plateau Fracture	Cat II					
Essential Hypertension	Cat III (Not Unfitting)	Hypertension	7101	10%	20090717	
OSA (Predating Service Entry)	Cat III (Not Unfitting)	Sleep Apnea	6847	50%	20090717	
Hyperlipidemia	Cat IV (Not a Disability)	No VA Placement	
Nicotine Dependence	Cat IV (Not a Disability)	No VA Placement	
COMBINED RATING: 10%	COMBINED RATING OF ALL VA CONDITIONS: 60%	

ANALYSIS SUMMARY:

Post-Traumatic Osteoarthritis of the Left Knee. According to the service treatment record and MEB narrative summary (NARSUM), the CI’s left knee condition began in March 2004 after striking his left knee and fracturing his left tibial plateau during a motor cycle accident. An orthopedic examination on 21 July 2008, 7 months prior to separation, noted complaints of chronic left knee pain and stiffness. Physical examination showed a normal gait and mild left knee medial and lateral tenderness. Left knee flexion was 130 degrees (normal 140) and extension was 0 degrees (normal) with 2+ patellofemoral crepitus and mild discomfort in the lateral facet. There was 1+ valgus instability. The diagnosis was left knee tri-compartmental osteoarthritis. The 31 July 2008 MEB NARSUM examination referenced physical examination findings from the aforementioned orthopedic examination. Left knee X-ray and MRI from

January 2008 revealed moderate to marked degenerative joint disease with extensive areas of cartilage loss predominantly in the lateral tibial plateau and patellofemoral joint, as well as anterior cruciate ligament (ACL) attenuation (weakening). Orthopedic consult indicated the CI would need “a total knee replacement in the not too distant future.” The 13 August 2008 NARSUM addendum noted a left knee with full extension and lacking 10 degrees of flexion. There was 1+ effusion and patellar crepitus with range of motion (ROM).

At the 17 July 2009 VA Compensation and Pension (C&P) examination, 5 months after separation, the CI reported constant left knee pain with associated weakness, stiffness, swelling, instability, fatigability, and lack of endurance. The CI reported flare-ups of pain rated 8/10, occurring 4 times weekly, lasting a few hours each time and precipitated by running or walking. Physical examination showed a non-antalgic gait. Left knee flexion was 100 degrees and extension was 0 degrees. Painful motion was present and there was additional pain with no additional loss of motion with repetition.

The panel directed attention to its rating recommendation based on the above evidence. The PEB rated the left knee condition 10%, analogously coded 5099-5003 (degenerative arthritis). The PEB’s Category II condition “left knee osteoarthritis s/p tibial plateau fracture,” which contributed to the primary condition, is intrinsic to the rated condition and a separate rating cannot be supported without pyramiding (VASRD §4.14); thus, it is appropriately subsumed under the same rating. The VA rated the left knee condition 10%, dual coded 5010-5262 (arthritis, due to trauma-tibia and fibula, impairment), based on the C&P examination, citing limited painful ROM.

The panel considered multiple VASRD knee and analogous codes, but most were less applicable and/or not advantageous for rating. The panel then considered alternative rating under code 5262. Given the significant underlying pathology with in-Service findings of ACL attenuation, knee instability, crepitus, effusions, X-rays showing marked degeneration, and extensive loss of cartilage, the panel majority agreed the disability picture at separation was closest to the “moderate” (20%) knee disability level. After due deliberation, considering all the evidence and mindful of VASRD §4.3 (reasonable doubt), the panel recommends a disability rating of 20% for the left knee condition, coded 5299-5262.

Contended PEB Conditions: Essential Hypertension, Obstructive Sleep Apnea (OSA), Hyperlipidemia, and Nicotine Dependence. 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 or implicated in the commander’s non-medical assessment. All conditions were forwarded on the NAVMED 6100/1. Hyperlipidemia and nicotine dependence are conditions not constituting a physical disability, IAW DoDI 1332.38. Therefore, the panel has no basis for recommending either as unfitting. 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 post-traumatic osteoarthritis of the left knee with left knee osteoarthritis status post tibial plateau fracture, the panel majority recommends a disability rating of 20%, coded 5299-5262 IAW VASRD §4.71a. The single voter for dissent recommends no change and did not elect to submit a minority opinion. In the matter of the contended essential hypertension and obstructive sleep apnea conditions, the panel recommends no change from the PEB determinations as not unfitting. In the matter of the contended hyperlipidemia, and nicotine dependence condition, the panel agrees it cannot recommend either for additional

disability  rating.	There are no other conditions within the panel’s scope of review for consideration.

The panel recommends the CI’s prior determination be modified as follows, effective the date of medical separation:

CONDITION	VASRD CODE	PERMANENT RATING	
Post-Traumatic Osteoarthritis of the Left Knee withLeft Knee Osteoarthritis status post Tibial Plateau
Fracture	5299-5262	20%	

DEPARTMENT OF THE NAVY
SECRETARY OF THE NAVY COUNCIL OF REVIEW BOARDS 720 KENNON STREET SE STE 309
WASHINGTON NAVY YARD, DC 20374-5023

Ill REPLY REFER TO:
1850
CORB:003 12 Oct 20

From: To:

Subj:

Ref:

Director, Secretary of the Navy Council of Review Boards 

PHYSICAL DISABILITY BOARD OF REVIEW (PDBR)

(a) DoDI 6040.44
(b)	PDBR ltr of 7 Feb 20
(b)	

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

2.	On 7 October 2020, the Assistant Secretary of the Navy (Manpower & Reserve Affairs) took action in your case by accepting the recommendation of the PDBR. Accordingly, your records will be corrected to reflect an increase in the disability rating awarded by the Department of the Navy Physical Evaluation Board (PEB) from 10% to 20% without re-characterization of your discharge.

3.	For your information, since all disability ratings from 0% to 20% qualify for disability severance pay, the above stated increase will not result in your entitlement to additional compensation.

4.	The Assistant Secretary's determination, which represents final action in your case by the Department of the Navy, has been forwarded to the Navy Personnel Command for appropriate changes to your personnel records and notification to you upon completion.