DEPARTMENT O F  THE  NAVY 

B O A R D   FOR  C O R R E C T I O N  O F  N A V A L   R E C O R D S  

2   N A V Y   A N N E X  

W A S H I N G T O N   D C   2 0 3 7 0 - 5 1  0 0  

JRE 
Docket  No:  5891-98 
23 April 2001 

This is in  reference to  your application for correction of  your  naval  record  pursuant to the 
provisions of  title  10 of  the United  States Code, section  1552. 

A  three-member panel of  the Board  for Correction of  Naval  Records,  sitting in  executive 
session, considered your application on  12 April  2001.  Your allegations of  error and 
injustice were reviewed  in  accordance with  administrative regulations and  procedures 
applicable to the proceedings of  this Board.  Documentary material considered by  the Board 
consisted of  your application, together with  all  material submitted in  support thereof, your 
naval  record and  applicable statutes, regulations and  policies.  In  addition, the Board 
considered the advisory opinion furnished by  a designee of  the Specialty Leader for 
Orthopedic Surgery, dated 23 February 2000, and  the Director, Naval  Council of  Personnel 
Boards dated  18 December 2000, a copy of  which  is attached. 

After careful and  conscientious consideration of  the entire record, the Board  found that the 
evidence submitted was  insufficient to establish  the existence of  probable material error or 
injustice.  In  this connection, the Board  substantially concurred  with  the comments contained 
in  the advisory opinion provided by  the Director, Naval  Council of  Personnel Boards. 
Accordingly, your application has been  denied.  The names and  votes of the members of  the 
panel will be furnished upon  request. 

It is regretted  that the circumstances of  your case are such  that  favorable action cannot be 
taken.  You  are entitled to have the Board  reconsider its decision upon  submission of  new 
and  material evidence or other matter not  previously considered by  the Board.  In  this 
regard,  it is important to  keep in  mind  that a presumption of  regularity attaches to all official 

Consequently, when applying for a correction of an official naval  record, the burden is on the 
applicant to demonstrate the existence of probable material error or injustice. 

Sincerely, 

W. DEAN PFEIFFER 
Executive Director 

Enclosure 

DEPARTMENT OF THE NAVY 

NAVAL COUNCIL OF PERSONNEL BOARDS 

WASHINGTON NAVY YARD 

720 KENNON STREET SE RM 309 
WASHINGTON. DC  20374-5023 

IW REPLY REFER TO 

5420 
Ser: 00-27 
18 Dec 00 

From:  Director, Naval Council of Personnel Boards 
To: 

Executive Director, Board of Correction for Naval Records 

THE CASE O F   FORMER 

Ref:  (a) Chairman, BCNR JRE: jdh DN: 5891-98 ltr of 4 Oct 00 

(b) SECNAVINST l850.4D 

1.  This letter responds to reference  (a) which requested comments and 
a recommendation regarding petitioner's request for correction of his 
records to show he was unfit at the time of his discharge from the 
naval service.  He was discharged on 15 May 1998 for failing to meet 
the required weight standards.  We have determined the evidence in this 
case does not support the petitioner's request for a change of records. 

2.  The petitioner's case history, contained in reference (a), was 
thoroughly reviewed in accordance with reference  (b) and is returned 
The following comments and recommendations are provided: 

a.  On 24 September 1994, the member suffered an anterior cruciate 

ligament tear.  He was never able to gain complete extension of his 
right knee despite vigorous physical therapy and arthroscopy. 

b.  The service member suffered from the troublesclme residuals of 
his knee injury.  In contrast to the BCNR application, the member did 
have one MEB following his first surgical intervention in September of 
1994 that recommended a one-year period of limited duty. 

c.  The arthroscopic repair of the member's ACL Deficiency left him 

with a persistent, frustrating, but relatively mild flexion 
contracture. 

d.  The most ~ c c c ~ i t  surgical at.LmpL of L e c u l - d   to c o l ~ ' c c L  the 

injury occurred on 28 October 1997 and appears to have resulted in mild 
improvement.  The most recent health record entries list a contracture 
in the 5-8 degree range.  This range is below the mini.mum threshold9 for 
compensability under VASRD Code 5261. 

e.  The service member's right knee injury may have contributed to 

this member's weight control problems, but was not of sufficient 
severity to classify him as unfit. 

3 .   In summary, the record in this case suggests a frustrating injury 
that likely contributed to a more sedentary life style, but did not 
result in significant decrement, for disability purposes, in his 
ability to perform his duties.  The record in this case does not 
support a correction of the petitioner's records to reflect he was 
unfit at the time of his discharge.  Accordingly, the petitioner's 
request should be denied. 

.  Subj :  REQUEST  FOR  COMMENTS  AND  RECOMMLLID~TION I N   THE  CASE OF FORMER 

a 

u 

NAVAL MEDICAL CENTER 

SAN DIEGO, CALIFORNIA 92134-5000 

23 FEB 00 

FROM : 

-CAPT 

SUBJECT : 

ORTHOPEDIC DEPARTMENT 
NAVAL MEDICAL CENTER, SAN DIEGO 

MC  USN 

CHAIRMAN 
BOARD FOR CORRECTION OF NAVAL RECORDS 

REFERENCES : 
A.  Letter from the Chairman, Board of Correction of Naval 
Records, docket #5891-98, dated 1/5/00. 

B.  Letter from " to the Director of Board of 

Correction of Naval Records, dated 7/1/98. 
C.  Letter from -to 
5 / 2 1 / 9 8 .  
D.  The medical records o- 

. 

- 

- 

the Honorable Norm Dix, dated 

This letter is in response to Reference A, w 
comments and recommendations in the case of 
References B, C, and D have been reviewed and the-following 
summarization and recommendations are submitted. 

References B and C were reviewed and numerous false statements 
were noted, which require clarification.  The patient states, "I 
spent a year on limited duty and was cleared for full duty by his 
wife, a practicing Podiatrist."  This statement is incorrect. 

returned to full duty by an Orthopedic Surgeon, 

The patient states, "I have been forced to maintain the same 
standard as a perfectly healthy sailor."  This also is incorrect. 
There is documentation in the record that the pat.ient was not 
required, nor did he complete the physical readiness test at any 
time after his surgery.  This test requires the individual to run 
1-1/2 miles in addition to other activities, two times per year. 

The patient states, "I did not receive the medical support I 
should have for an injury of this magnitude."  His record 
documents good care from the time of his injury to the time of 
his discharge, with appropriate referral to Physical Therapy, 
appropriate surgery, followed by physical therapy, and overall 
appropriate treatment for his injury. 

PATIENT: 
SSN : 

Physician Copy 

Page 1 of 4 

The patient states that "I was the first person to undergo a 
notchplasty at the Bremerton Naval Hospital."  This statement is 
also false.  A notchplasty is a very common procedure performed 
during nearly every anterior cruciate ligament reconstruction. 
In addition, it is a surgery that is frequently performed in the 
event of graft impingement after anterior cruciate ligament 
reconstruction, when a patient  fails to return to full extension, 
as in this case. 

sustained an 

A  medical record review reveals that ~r.- 
injury to his knee while playing basketball on 2/21/93.  He was 
referred to Orthopedic Surgery the following day, and a diagnosis 
of anterior cruciate ligament injury was made.  The patient was 
placed on crutches and referred to Physical Therapy for range of 
motion activities.  On 3/29, he was seen back by Orthopedic 
Surgery; his examination confirmed anterior cruciate ligament 
laxity with a positive Lachman's test; however, a good endpoint 
was noted and it was elected to proceed with continued 
rehabilitation.  The patient was placed on light duty and 
quadriceps strengthening exercises were begun.  At  followup on 
8/20, a LIDO test, which measures strength and endurance of the 
muscles, revealed nearly symmetric strength of both the 
quadriceps and the hamstrings.  Because of the perception of 
instability, a brace was ordered.  Approximately one year later, 
the patient was referred again to Physical Therapy on 6/6/94, 
with a complaint of multiple giving-way episodes.  As a result, 
he was scheduled for anterior cruciate ligament reconstruction. 
On 9/20, the patient underwent the procedure, a right knee 
anterior cruciate ligament reconstruction with bone-patellar 
tendon-bone autograft.  During the procedure, a meniscal tear was 
found and this was debrided.  After the procedure, the patient 
was placed on 30 days of convalescent leave.  In addition, he was 
placed on a Limited Duty Board for a period of 12 months.  He was 
protected postoperatively in a Bledsoe-type brace.  At his first 
followup on 9/28/94, the patient was referred to Physical 
Therapy.  His motion at that time was 0-100 degrees of flexion. 
This is considered good motion one week postoperatively.  On 
9/30, his sutures were removed; range of motion at that time was 
noted to be 0-95 degrees.  Physical therapy was continued. 

On 10/25, approximately one month postoperatively, the patient 
was noted to be improving with the therapy.  His pain had  * 
decreased to 2/10; however, his motion, specifically full 
extension, had decreased.  His motion was measured at 5 degrees 
to 115 degrees.  This indicates that the patient lacked 5 degrees 
of full extension.  He was continued in therapy and his motion 
improved.  On 11/2, motion was noted to be 2 degrees to 100 
degrees of flexion.  At that time, a DonJoy anterior cruciate 
ligament functional brace was ordered.  At  further followup on 
11/8 and then again on 2/7/95, a 5-degree flexion contracture .was 

PATIENT : 
SSN : 

Physician Copy 

Page 2 of 4 

again noted.  Maximum flexion had  increased to 130 degrees, as 
expected. 

On 5/5/95, the patient had a reinjury when he slipped and injured 
his knee.  He was seen in Orthopedics on 5/9/95; range of motion 
at that time was 15 degrees to 135 degrees of flexion.  No 
instability was noted.  X-rays and a Dyna splint were ordered.  A 
Dyna splint is a dynamic splint which will aid a patient  in 
returning to full extension of the knee.  In addition, poor 
patellar mobility was noted.  A diagnosis of "arthrofibrosis" was 
made.  The patient was referred back to the original Surgeon, 
with a recommended debridement procedure.  At  followup in the 
Orthopedic Clinic, it was decided to continue wit 
recommended, and on 11/2, the patient was seen by 
the Surgeon's wife, who is also an Orthopedic Sur 
that the patient was still unable to run greater than one-quarter 
mile; however, recommended return to full duty at that time.  At 
this point, the patient had been on limited duty for over one 
year. 

The patient was transferred to Bremerton, Washington on 5/9/96. 
He was referred to Orthopedic Surgery there, complaining of 
popping, pain, and swelling.  An examination revealed a 1+ 
Lachman test and a  10-degree flexion contracture.  The patient 
was again referred to Physical Therapy for range of motion 
exercises. 

Approximately one year later, on 4/24/97, the patient had still 
not run the physical readiness test.  He was referred to 
Orthopedics for evaluation and was found to have a 12-degree 
flexion contracture, and at that time he was scheduled for 
arthroscopic surgery. 

On 5/10/97, he underwent arthroscopic surgery with debridement of 
soft tissues and a bony notchplasty.  This is a procedure which 
.creates more room for the anterior cruciate ligament graft and 
prevents impingement anteriorly when the leg is brought into full 
extension.  Postoperatively, the patient was treated with serial 
casting to attempt to stretch the soft tissues and bring the 
patient into full extension.  At his first visit nine days 
postoperatively, range of motion was noted to be 16 degrees,.to 
138 degrees.  Slowly over time, his extension improved to 9 
degrees; this was documented on 7/23/97.  At that time, the 
casting was discontinued and dynamic stretching with prone hangs 
was recommended.  Because the extension did not significantly 
improve over time, the patient was referred to Dr. Covey, a 
Sports Medicine Specialist.  He felt that the problem was 
anterior placement of the graft on the tibia1 side.  After 
discussion with the patient, it was recommended that the graft be 
excised and motion be regained, and then consider reconstructing 
-. 
the ligament at a later date. 

I 

PATIENT : 
S S N :  

Physician Copy 

On 10/21/97, the patient underwent a graft excision, as well as 
soft tissue debridement from the anterior portion of the joint. 
Again noted was thd partial meniscectomy of the medial meniscus 
during that arthroscopy.  Again, serial casting was attempted, 
and the patient's motion improved with time.  On 1/23/98, 
extension had improved to 8 degrees, and on 3/11/98, which 
appears to be his last orthopedic visit prior to discharge, range 
of motion was noted to be 3 degrees to 143 degrees of flexion. 
There was a positive Lachman's test.  In addition, the patient 
was noted to have patellofemoral findings consistent with the 
chondromalacia of the patella, which had been noticed at previous 
arthroscopy.  The patient ultimately underwent Administrative 
Separation from the Navy, because he failed to maintain weight 
standards.  Surgery was discussed at that final visit.  The 

. .   Surgeons recommended reconstruction with hamstring autograft, and 

the patient refused further surgery. 

It is my opinion that the patient was treated appropriately.  The 
most likely reason for failure to regain full extension after his 
first surgery was that the tibia1 channel was created more 
anteriorly than desired.  This statement is based solely on 
review of the records, as I have no x-rays to review and no 
patient to examine.  Heroic attempts were made to return motion 
to normal and nearly normal motion was documented at the 
patientls.final visit.  It is difficult to say at this point, 
what disability the patient has.  However, it would be expected 
that the patient currently may have patellofemoral pain secondary 
to chondromalacia of the patellofemoral joint, which was noted at 
arthroscopy.  He may have instability because of the resection of 
the anterior cruciate ligament graft.  Motion has been returned 
to a functional level.  It is my opinion that it would have been 
reasonable to refer this patient to the Physical Evaluation Board 
for a disposition, because of his lack of function; however, 
Administration Separation was performed prior to this becoming an 
issue.  Because it is likely that the patient continues to have 
some disability, it is recommended that his records be amended to 
reflect that he left the Navy with this disability, and a 

he patient would be b e r l c f i c i a l   in 

his disability. 

CAPT MC USN 

PML:EDiX11045 
D:  02/23/00 11:OO  T:  02/24/00 07:23  DOCUMENT: 200002230799800400 

PATIENT: 
SSN : 

Physician Copy 

Page 4 of 4