RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2014-00536
BRANCH OF SERVICE:  COAST GUARD	SEPARATION DATE:  20071126

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty, E5, Damage Controlman, medically separated for left knee pain and loss of use of left knee, with a combined disability rating of 20%.  

CI CONTENTION:  The applicant requests review of all conditions.  The applicants complete submission is at Exhibit A.  

SCOPE OF REVIEW:  The Board’s scope of review is defined in DoDI 6040.44.  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 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 Veterans Affairs Schedule for Rating Disabilities (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 PEB - 20070503	VARD - 20080624	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Left Knee, Chondromalacia	5099-5003	10%	Left Knee Chondromalacia, Status Post Ligament Repairs	5260	10%	20080512	
Left Knee Extension	5314	10%					
COMBINED RATING:  20%	COMBINED RATING OF ALL VA CONDITIONS:  30%	

ANALYSIS SUMMARY:

Left Knee.  The record shows that the CI dislocated his left kneecap (patella) prior to his first enlistment.  This was disclosed and he was cleared for accession after an orthopedic evaluation.  Although he did have some knee trouble during his first enlistment, he successfully completed it and was then cleared for re-enlistment in 2004.  Again, he initially did well, but subsequently had recurrent dislocation of the patella which was treated surgically on 11 April 2006.  Despite rehabilitation, he continued to have pain and limited function of the left knee.  He had further aggravation during increased activity in preparation for a training activity.  His activities were restricted and he again underwent rehabilitation.  Magnetic resonance imaging (MRI) on 18 July 2006 showed post-surgical changes and degeneration of the kneecap cartilage (chondromalacia patella [CMP]).  In December 2006, it was determined that he was unlikely to return to full duty in his current rate and a Medical Evaluation Board (MEB) was recommended.  The narrative summary (NARSUM) dated 4 December 2006, almost 12 months prior to separation, noted that the CI had been on Limited Duty (LIMDU) for 5 months and had not been able to return to full duty despite surgery, rehabilitation, and injections.  An orthopedic note the same day noted a stable knee with full range-of-motion (ROM).  He was diffusely tender and compression of the patella was painful (consistent with CMP).  Atrophy of the quadriceps muscles was noted.  Following the NARSUM, the CI underwent a series of 3 injections of Supartz (a joint ‘lubricant’).  He reported some improvement, but did not return to full activity.  At the VA Compensation and Pension (C&P) examination performed on 12 May 2008, 6 months after separation, the CI reported persistent and progressive knee pain, especially with stair climbing.  His gait was normal.  The ROM was reduced at 120 degrees of flexion and painful, but exceeded the flexion noted for the unaffected right knee which was 115 degrees and also painful.  X-rays showed post-surgical changes.  The previously noted atrophy was now absent and strength was normal.  The knee was tender, but without effusion or swelling.  The examiner stated that there were no other objective joint findings, implying that the knee was stable.  

The Board directed its attention to its rating recommendation based on the above evidence.  The PEB rated the left knee at 10% for CMP, coded 5099-5003 (analogous to degenerative arthritis) and also at 10% for muscle Group XIV impairment, coded 5314, at the moderate level.  The Board noted that the atrophy present at the MEB examination, 12 months prior to separation and 7 months after surgery, was absent at the VA examination accomplished 6 months after separation.  The VA C&P examination is more remote from surgery and closer to separation, and therefore more probative for rating at separation.  It does not support the use of the code 5314.  However, the Board does not recommended a lower rating than that assigned by the PEB.  The ROM limitation was non-compensable and instability was not documented.  The Board found no route to a rating higher than that adjudicated by the PEB.  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 and muscle Group XIV conditions.  

BOARD FINDINGS:  In the matter of the left knee and muscle Group XIV conditions and IAW VASRD §4.71a and VASRD §4.73, the Board unanimously recommends no change in the PEB adjudication.  There were no other conditions within the Board’s scope of review for consideration.  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 20140123, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans’ Affairs Treatment Record

Commandant
United States Coast Guard	Mail Stop 7907
2703 Martin Luther King Jr. Ave SE
Washington, DC 20593-7907
Staff Symbol: CG-1
Phone: (202) 475-5000

								   1850

Dear XXXXXXXXXX,
I am the Designated Decision Authority for the Coast Guard on applications submitted to the Department of Defense Physical Disability Board of Review (PDBR).  Under the authority of Title 10, United States Code, section 1554a, I accept the PDBR’s recommendation in your case (Case Number PD-2014-00536) and decline to modify your findings. 

Enclosed for your information are a copy of the PDBR’s recommendation and a copy of the record of proceedings. 

A copy of this decision has also been provided to Coast Guard Enlisted Personnel Management Branch, the PDBR, and the Department of Veterans Affairs. 

If you have any further questions, please contact the Coast Guard Personnel Service Center at (202)795-6645. 
	Sincerely,

2 Enclosures		
	
Copy:	CG Personnel Service Center (EPM-1)
DoD Physical Disability Board of Review
Department of Veterans Affairs