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AF | PDBR | CY2013 | PD-2013-01460
Original file (PD-2013-01460.rtf) Auto-classification: Denied
RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME: XXXXXXXXXXXXXXX   CASE: PD-2013-01460
BRANCH OF SERVICE: NAVY  BOARD DATE: 20150213
SEPARATION DATE: 20040901


SUMMARY OF CASE: Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E-5 ( Surface Warfare ) medically separated for a left knee injury. The condition could not be adequately rehabilitated to meet the requirements of his Rating or physical fitness standards. He was placed on limited duty three times and then referred for a Medical Evaluation Board (MEB). The knee conditio n, characterized as “anterior cruciate ligament deficiency st atus post anterior cruciate reconstruction , ” was forwarded to the Physical Evaluation Board (PEB) IAW SECNAVINST 1850.4E. The MEB also identified and forwarded four other conditions for PEB adjudication to include h istory of arthrofibrosis of his l eft knee, which is now resolved; history of fat p ad scarring of his left knee; history of osteochondral defect lesion, status post debridement ; and q uadriceps atrophy, status post multiple surgeries. The Informal PEB adjudicated the left knee injury condition as unfitting, rated 10% with likely application of the Veterans Affairs Schedule for Rating Disabilities (VASRD). The remaining (left leg) q uadriceps atrophy, status post multiple surgeries condition was determined to be C ategory II ( contributed to the u nfitting c ondition). The PEB did not address h istor ies of arthrofibrosis , fat pad scarring, and osteochondral defect s , status post debridement). The CI made no appeals and was medically separated .


CI CONTENTION: The CI elaborated no specific contention in his application.


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 when specifically requested by the CI, those conditions identified by the PEB, but determined to be not unfitting. Any conditions outside the Board’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/Naval Records. Furthermore, the Board’s authority is limited to assessing the fairness and accuracy of PEB rating determinations and recommending corrections, where appropriate. The Board’s assessment of the PEB rating determinations is confined to review of medical records and all available evidence for application of the VASRD standards to the unfitting medical condition at the time of separation. The Board 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, operating under a different set of laws. The Board gives consideration to VA evidence, particularly within 12 months of separation, but only to the extent that it reasonably reflects the severity of the disability at the time of separation.









RATING COMPARISON :

Service IPEB – Dated 20040616
 VA - (5 Mos. Post-Separation)
Condition
 Code Rating Condition Code Rating Exam
ACL Deficiency St atus Post Reconstruction 5299-5003 10% Residuals, Left Knee with Quadriceps Atrophy,
 Post-Operative		 5257 10% 20050125
Quadriceps Atrophy, Status Post Multiple
 Surgeries		 Cat II
Other x 0 (Not in Scope)
 Other x 9 20050125
Rating: 10%
 Combined: 50%
Derived from VA Rating Decision (VA RD ) dated 200 50307 .


ANALYSIS SUMMARY:

Left Knee Condition(s). All diagnoses and sources of left knee disability were considered for rating. The narrative summary (NARSUM), written 4 months prior to separation, stated that the CI hyperextended his left knee while playing basketball in 2002. He was initially treated conservatively but then reinjured it. The CI underwent operative repair of his anterior cruciate ligament (ACL), and debridement of the medial meniscus, and bilateral femoral osteochondral defects (damage to the cartilage and underlying bone). During extensive physical therapy, he reported instability, which resulted in another left ACL reconstruction. The CI reinjured his knee postoperatively during physical therapy and underwent another debridement. The CI stated that he was able to play tennis and jog with a brace, continued to have stiffness, edema and “popping” without instability or pain in his knee, and was undergoing quad strengthening for atrophy and weakness with increased activity. The NARSUM examiner documented visible quadriceps atrophy of the left thigh, a range-of-motion (ROM) of 3-127 degrees (normal 0-140 degrees), mild patellar crepitus, and no instability (negative varus/valgus stress, McMurray, Lachman, pivot shift, and anterior/ posterior drawer testing).

At the VA Compensation and Pension (C&P) exam, performed 5 months after separation, the CI reported pain in both knees for 2-3 days after playing tennis, occasional giving way causing him to fall, frequent use of a full knee brace, ability to play tennis once weekly and run on a treadmill. The examiner documented a normal gait and posture, prominent crepitus with slight swelling below the patella, ROM 0-140 degrees (normal 0-140) with painful motion occurring at 120 degrees, and normal motor strength with 1.5 cm atrophy of the left thigh.

The Board directed attention to its rating recommendation based on the above evidence. The PEB assigned a 10% rating under analogous code 5299-5003 (arthritis, degenerative). The VA assigned a 10% rating coded as 5257 (knee, other impairment of) citing functional impairment from painful motion, crepitus, muscle atrophy and swelling. In the months prior to and after separation, examinations consistently documented a stable knee with non-compensable ROMs. Mild crepitus was noted 4 months prior to separation and was also confirmed, along with painful motion and swelling, on the after separation VA C&P exam. Board members agreed that a higher evaluation of 20% was not warranted as there was no evidence of moderate subluxation or instability; no frequent episodes of locking, pain and effusion into the joint; no compensable limitation of flexion or extension; and no documented weakness after increased activity.

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 left knee condition.


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 left knee condition and IAW VASRD §4.71a, the Board 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 re-characterization of the CI’s disability and separation determination.


The following documentary evidence was considered:

Exhibit A. DD Form 294, dated 20130917, w/atchs
Exhibit B. Service Treatment Record
Exhibit C. Department of Veterans’ Affairs Treatment Record








                  XXXXXXXXXXXXXXX
                  President
                  DoD Physical Disability Board of Review 






MEMORANDUM FOR DIRECTOR, SECRETARY OF THE NAVY COUNCIL OF REVIEW BOARDS
 Subj:    PHYSICAL DISABILITY BOARD OF REVIEW (PDBR) RECOMMENDATION
Ref:     (a) DoDI 6040.44
(b) CORB ltr dtd XX Jun 15

In accordance with reference (a), I have reviewed the cases forwarded by reference (b), and, for the reasons provided in their 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:

-        XXXXXXXXXXXXXXXXXXXX, former USN
-        XXXXXXXXXXXXXXXXXXXX, former USN
-        XXXXXXXXXXXXXXXXXXXX , former USN
-        XXXXXXXXXXXXXXXXXXXX, former USN







XXXXXXXXXXXXXXXXXXXX
Assistant General Counsel (Manpower & Reserve Affairs)
        

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