RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXXX	CASE:  PD-2014-01403
BRANCH OF SERVICE:  Navy 	SEPARATION DATE:  20081202

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an activated Reserve E5, Navy Law Enforcement Specialist, medically separated for “chondromalacia of the right knee involving the patellofemoral joint and the medial compartment,” with a disability rating of 10%.  

CI CONTENTION:  He was not evaluated for his left knee condition.  The applicant’s 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 Physical Evaluation Board (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 - 20080513	VARD - 20090904	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chondromalacia of Right Knee	5299-5003	10%	Right Knee Strain DJD, S/P Meniscal Repair	5260-5010	10%	20090713	
Right Knee Medial Meniscal Tear	Cat II					
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  40%	

ANALYSIS SUMMARY:  

Chondromalacia of the Right Knee Involving the Patellofemoral Joint and the Medial Compartment Condition (with Right Knee Medial Meniscal Tear).  According to service treatment records and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI underwent right knee surgery in August 2008 for a torn meniscus and debridement/chondroplasty.  Despite treatment, the CI’s knee condition could not be adequately rehabilitated to meet the physical requirements of the CI’s military specialty and was referred for an MEB.  The MEB physical examination on 12 March 2008, performed 7 months before separation, was prior to the CI’s surgery in August 2008.  During a physical therapy clinic appointment on 10 November 2008, 1 month before separation (3 months after surgery), the CI reported his right knee felt “okay,” but when he stood for long periods it hurt and his right foot went numb.  The examiner recorded the ROM as flexion of 137 degrees (normal 140) and extension of 8 to 0 degrees (normal 0).  There was no further limitation of ROM with repetitions.  

At the VA Compensation and Pension (C&P) examination on 13 July 2009, performed 7 months after separation, the CI complained of right knee pain, stiffness, and weakness without locking or episodes of dislocation or subluxation.  Physical exam showed an antalgic gait.  There was crepitation and ROM was flexion of 120 degrees (normal 140) and extension of 0 degrees (normal).  The knee was stable and X-rays showed degenerative joint disease.  On separate general VA exam that day there was no motor or sensory loss documented and ROM and gait were normal.  

The Board directed attention to its rating recommendation based on the above evidence.  The PEB rated the right knee condition 10% (coded 5299-5003, (degenerative arthritis).  The Navy PEB also listed “right knee medial meniscal tear which is asymptomatic based on the patient's history and physical examination” as a related Category II condition (a condition that contributes the primary unfitting condition but is not separately ratable).  The impairment from the right knee medial meniscal tear was subsumed under the overall rating for the right knee condition as meniscal rating includes painful motion (§4.14 avoidance of pyramiding; more than one rating based on the same impairment is prohibited).  The VA rated the right knee condition 10% (coded 5260-5010, leg, limitation of flexion – arthritis due to trauma), citing limitation of flexion, based on the post-separation C&P examination.  

There was no limitation of motion which attained a minimum rating under the diagnostic codes for limitation of flexion or extension (5260, 5261). However, there was evidence of painful motion with functional loss supporting a 10% rating (based on §4.59, §4.40 and §4.45) as adjudicated by the PEB.  The examinations proximate to separation did not demonstrate the presence of ligamentous instability or laxity (5257), frequent locking with effusions or any indication of dislocated meniscus or loose body (5258), to support a rating under the respective codes.  There was no fracture, non-union, or malunion of the femur or tibia to support consideration under the respective codes for knee impairment related to long bone conditions (5255, 5262).  There is therefore no VASRD §4.71a route to a rating higher than the 10% adjudicated by the PEB under any applicable code, and no grounds for additional rating based on the presence of instability.  The Board also noted a 10% rating was supported under VASRD diagnostic code 5259 (cartilage, semilunar, removal of, symptomatic) but provided no benefit to the CI, as meniscal coding includes painful motion.  

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 knee condition(s).  

BOARD FINDINGS:  In the matter of the right knee condition and IAW VASRD §4.71a, the right knee condition(s) 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 20140321, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

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 16 Mar 16

      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 USMC 
	- XXXXXXXXXXXXXXXXXXXX, former USMC
	- XXXXXXXXXXXXXXXXXXXX, former USMC

						 XXXXXXXXXXXXXXXXXXXX
	     				  	Assistant General Counsel
						 (Manpower & Reserve Affairs)