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AF | PDBR | CY2012 | PD2012 00365
Original file (PD2012 00365.rtf) Auto-classification: Denied
RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME: XXXXXXXXXXXXXXXXXX         CASE: PD1200365
BRANCH OF SERVICE: NAVY  BOARD DATE: 20131107
SEPARATION DATE: 20050210


 SUMMARY OF CASE : Data extracted from the available evidence of record reflects that this covered individual (CI) was a Reserve HM3/E-4 (HM3/Field Medic) medically separated for bilateral knee pain with bilateral synovectomies. The CI served on active duty in the Navy from 1985 through 1989; and then transferred to the Naval Reserve. In March 2003 while attending jump school, he suffered significant bilateral knee pain, was unable to walk and had markedly swollen knees after repeated practice landings. He ultimately underwent bilateral knee arthroscopies in 2003, with the post - operative diagnoses of internal derangement of both knees; synovitis and small tear of the anterior horn of the lateral meniscus of the left knee. Although these surgeries, associated physical therapy and non - steroidal medications brought some improvement in his knee function, his knees could not be adequately rehabilitated to meet the physical requirements of his Rating or satisfy physical fitness standards and was referred for a Medical Evaluation Board (MEB). The knee conditions, characterized as “Bilateral Knee Pain with Synovectomies” and “Left Anterior Horn, Lateral Meniscus Tear, Status Post Debridement,” were forwarded to the Physical Evaluation Board (PEB) IAW SECNAVINST 1850.4E. No other conditions were submitted by the MEB. The PEB adjudicated “Bilateral Knee Pain with Svnovitis, Status Post Bilateral Knee Arthroscopies, with Synovectomies” as unfitting, rated 10% for each knee and characterized the “Left Anterior Horn, Lateral Meniscus Tear, Status Post Debridement” as Category II (a condition that is related to and contributes to the unfitting condition) with likely application of the Veterans Affairs Schedule for Rating Disabilities (VASRD). The CI made no appeals and was medically separated.


CI CONTENTION: “Upon further examination both knees were found to be worse. Multiple surgeries have been performed on both knees. In addition, other conditions were in effect, and member was directed to have the VA "deal with them." This was documented into the members health record. These conditions include, mental, Cervical / Lumbar / sacral spine issues as well as, shoulder, migraine, heart, and finger injuries.”


SCOPE OF REVIEW: The Board’s scope of review is defined in DoDI 6040.44, Enclosure 3, paragraph 5.e.(2). It is limited to those conditions determined by the PEB to be unfitting for continued military service and those conditions identified but not determined to be unfitting by the PEB when specifically requested by the CI. The ratings for the unfitting bilateral knee conditions are addressed below. Of the conditions determined to be not unfitting by the PEB, members judged that the l eft a nterior h orn, l ateral m eniscus t ear condition was specified sufficiently in the application to meet the DoDI 6040.44 scope requirements; and is accordingly addressed below. The requested mental, cervical, lumbar and sacral spine issues, shoulder, migraine, heart and finger conditions were not identified by the PEB, and thus are not within the DoDI 6040.44 defined purview of this Board. Any conditions or contention not requested in this application or otherwise outside the Board’s defined scope of review remain eligible for future consideration by the Board for Correction of Naval Records.


 RATING COMPARISON :

Service IPEB – Dated 20041222
 VA - 3 yrs. Post-Separation
Condition
 Code Rating Condition Code Rating Exam
Bilateral Knee Pain with Synovitis s/p Synovectomies 5099-5003 10% Left Knee Internal Derangement 5261 40% 20080307
5099-5003 10% Right Knee Internal Derangement 5261 40% 20080307
Left, Lateral Meniscus Tear, Status Post Debridement Category 2 No VA Entry
No Additional MEB/PEB Entries
 Other x 10 2008 0307 & 0308
Combined: 20%
 Combined: 100%
Derived from VA Rating Decision (VARD) dated 20080414 (most proximate to date of separation; but 3 years post separation ).
Knee ratings based on VA C&P examination over three years after separation.


ANALYSIS SUMMARY: The Disability Evaluation System (DES) is responsible for maintaining a fit and vital fighting force. While the DES considers all of the member's medical conditions, compensation can only be offered for those medical conditions that cut short a member’s career and then only to the degree of severity present at the time of final disposition. The DES has neither the role nor the authority to compensate members for anticipated future severity or potential complications of conditions resulting in medical separation nor for conditions determined to be service-connected by the Department of Veterans Affairs (DVA) but not determined to be unfitting by the PEB. However, the DVA operating under a different set of laws (Title 38, United States Code), is empowered to compensate all service-connected conditions and to periodically re-evaluate said conditions for the purpose of adjusting the Veteran’s disability rating should the degree of impairment vary over time. The Board’s role is confined to the review of medical records and all evidence at hand to assess the fairness of PEB rating determinations, compared to VASRD standards, based on severity at the time of separation. The Board utilizes DVA evidence proximal to separation in arriving at its recommendations; and, DoDI 6040.44 defines a 12-month interval for special consideration to post-separation evidence. The Board’s authority as defined in DoDI 6044.40; however, resides in evaluating the fairness of DES fitness determinations and rating decisions for disability at the time of separation. Post-separation evidence therefore is probative only to the extent that it reasonably reflects the disability and fitness implications at the time of separation.

Bilateral Knee Pain With Synovitis, Status Post Bilateral Knee Arthroscopy With Synovectomy: After arthroscopic surgery with synovectomy performed on 14 July 2003 for bilateral knee injuries sustained in airborne training, the CI improved but could not meet his mission requirements for his Rating. The commander’s non-medical assessment which was undated, noted that the CI had to work outside of his Navy enlisted classification, could not take a physical training test and did not have good potential for continued service due to his injury. The MEB narrative summary performed on 8 November 2004, described that the CI although in no apparent distress was now handicapped as “… he can no longer run or sit or stand for prolonged periods of time. He is unable to march or climb stairs.” Examination of the knees noted no effusion, that he lacked 5 degrees of extension and had flexion to 95 degrees in both knees. Both knees were stable to stress of the ligaments from all four directions. The examiner also noted that discomfort prevented testing of the knee cap joint surface. The CI filed his original claim for VA benefits, 2 years after separation. At the VA Compensation and Pension exam performed 37 months after separation, the CI reported loss of extension in both knees and the VA adjudicated a rating of 40% based on loss of extension reported at that examination.

The Board directs attention to its rating recommendation based on the above evidence. The PEB rated the condition 10% for each knee, adjudicated under alternative code 5099-5003 (degenerative arthritis), with application of the bilateral factor for combined rating. A higher rating under this assigned code would require involvement of two or more major joints or two or more minor joints with occasional incapacitating exacerbations which was not evident in the service treatment record. The VA rating was based on an examination remote from separation and did not provide any information regarding the condition at the time of separation. The limitation of motion evidenced at the MEB examination did not attain a minimum rating under the VASRD diagnostic codes for limitation of flexion 5260 or extension 5261. There was no ligamentous injury or ligamentous instability to warrant a minimum rating under the code 5257 for knee instability. There was not a dislocated meniscus with frequent locking or effusion in either knee to assign ratings under code 5259. A rating no greater than 10% could be supported with application of §4.59 (painful motion) or §4.40 (functional impairment) or for symptomatic status post removal of semilunar cartilage 5258 (the CI underwent debridement but not complete removal). The Board found no evidence to support a rating higher than the 10% adjudicated by the PEB for each knee. The PEB also listed an associated diagnosis of left anterior horn lateral meniscus tear status post debridement as a Category II condition (contributes to the primary unfitting condition but is not separately ratable). The meniscus condition was not a separate disability and was considered under the rating for the knee condition. More than one rating based on the same impairment is prohibited (§4.14 avoidance of pyramiding). After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the Board concluded that there was insufficient cause to recommend a change in the PEB adjudication for the right and left knee conditions.


BOARD FINDINGS: IAW DoDI 6040.44, provisions of DoD or Military Department regulations or guidelines relied upon by the PEB will not be considered by the Board to the extent they were inconsistent with the VASRD in effect at the time of the adjudication. The Board did not surmise from the record or PEB ruling in this case that any prerogatives outside the VASRD were exercised. In the matter of the bilateral knee pain with synovitis condition and IAW VASRD §4.71a, the Board unanimously recommends no change in the PEB adjudication. There were no other conditions within the Board’s scope of review for consideration.


RECOMMENDATION: The Board, therefore, recommends that there be no recharacterization of the CI’s disability and separation determination, as follows:

UNFITTING CONDITION
 VASRD CODE RATING
Bilateral Knee Pain With Synovitis – Right 5099-5003 10%
Bilateral Knee Pain With Synovitis – Left 5099-5003 10%
COMBINED (w/ BLF)
 20%


The following documentary evidence was considered:

Exhibit A. DD Form 294, dated 20120408, w/atchs
Exhibit B. Service Treatment Record
Exhibit C. Department of Veterans’ Affairs Treatment Record




        
XXXXXXXXXXXXXXXXXX
President
Physical Disability Board of Review
MEMORANDUM FOR DIRECTOR, SECRETARY OF THE NAVY COUNCIL OF REVIEW
BOARDS

Subj: PHYSICAL DISABILITY BOARD OF REVIEW (PDBR) RECOMMENDATIONS

Ref: (a) DoDI 6040.44
(b) CORB ltr dtd 9 Apr 14

In accordance with reference (a), I have reviewed the cases forwarded by reference (b), and, for the reasons provided in their respective forwarding memorandums, approve the recommendations of the PDBR that the following individual’s records not be corrected to reflect a change in either characterization of separation or in the disability rating previously assigned by the Department of the Navy’s Physical Evaluation Board:

 - XXXXXXXXXXXXXXXXXX , former USN, XXX XX XXXX  

                                                      XXXXXXXXXXXXXXXXXX
                                            Assistant General Counsel
                  (Manpower & Reserve Affairs)

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