RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	    CASE:  PD-2014-01759
BRANCH OF SERVICE:  NAVY	SEPARATION DATE:  20080609

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an activated Reserve E6, Storekeeper, medically separated for “patellofemoral pain syndrome of the right knee (PFPS)” with a disability rating of 10%.

CI CONTENTION:  The CI did not have a specific contention related to his unfitting condition. The CI’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:  
IPEB - Dated 20080304	VARD - 20111107 	
Condition	Code	Rating	Condition	Code	Rating	Exam	
PFPS, Right Knee	5009-5003	10%	Right Knee Strain	5260	10%	20110902	
PFS, Left Knee	Cat II	Left Knee Strain	5260	10%	20110902	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  30%	

ANALYSIS SUMMARY:  

Patellofemoral Pain Syndrome (PFS), Right Knee.  The Medical Evaluation Board (MEB) narrative summary (NARSUM) was dated 27 November 2007, 6 months prior to separation, and noted a several year history of right knee pain since he twisted it while his foot was planted and he had his full weight on that leg.  Conservative management including medications, physical therapy, and a comfortable shoe failed to resolve his symptoms and he was referred for an MEB.  On examination, he had pain and limped favoring the right leg.  Compression of the knee was positive (tender).  The range of motion (ROM) was reduced as charted below.  However, signs of meniscal (cartilage cushions in the knee) injury were absent and the knee was stable.  He was able to heel and toe walk.  X-rays were unremarkable other than possible mild degeneration of the patellar (kneecap) tendon seen on an MRI dated 4 January 2007.  He was thought to have mild patellofemoral pain syndrome (a term used somewhat interchangeably with PFS).  

The VA C&P was performed 39 months after separation and was well outside the 12-month window for high probative value in assigning a rating at separation.  The CI reported ongoing pain with flares from (changes in) weather and increased activity.  The CI used a cane.  The ROM was reduced and motor function also reduced.  However, the knee was stable and without signs of meniscal disease.  X-rays were normal.  Painful motion was present.  

The goniometric evaluations in evidence which the Board weighed in arriving at its rating recommendation, with documentation of additional ratable criteria, are summarized in the chart below.

DOS 20080609
Knee ROM
(Degrees)	MEB ~6 Mo. Pre-Sep
(20071127) p.36	VA C&P ~39 Mo. Post-Sep
(20110902) p.124	
	Left	Right	Left	Right	
Flexion (140 Normal)	125	125	80	100	
Extension (0 Normal)	0	0	5	5	
Comment	Painful motion	Painful motion	
§4.71a Rating	10%	10%	10%	10%	

The Board directed attention to its rating recommendation based on the above evidence.  The PEB and VA both rated the right knee at 10%, coded 5009-5003 (analogous to degenerative arthritis) and 5260 (limitation in flexion), respectively.  The limitation in motion is not compensable, but painful motion supports a 10% rating IAW VASRD §4.59 (painful motion).  No route to a higher rating was found.  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.  

Patella Femoral Syndrome, Left Knee.  The PEB listed the left knee as a Category II condition, a condition that is related to the primary unfitting condition and contributes to the primary unfitting condition.  The Board’s first charge for this Category II condition is to assess whether it can be reasonably justified as separately unfitting for rating consideration.  The Board’s threshold for such determinations is reasonably unfitting and remains adherent to the DoDI 6040.44 “fair and equitable” standard.  The NARSUM noted an 8-month history of the left knee pain associated with overuse due to the right knee condition.  On examination, the ROM was symmetric with the right and painful at the end of motion, more so than on the right.  The right knee, though, was noted to be painful throughout the ROM.  The gait was antalgic, favoring the right.  Heel and toe walk were normal.  No effusion (fluid in the joint) was present and signs of instability or meniscal irritation were absent. The Board also noted that the commander recommended retention and thought that the CI was world-wide assignable.  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 as a Category II condition, and therefore no additional rating is recommended.  

BOARD FINDINGS:  In the matter of the right knee condition and IAW VASRD §4.71a, the Board unanimously recommends no change in the PEB adjudication.  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 patella femoral syndrome condition as a Category II condition, and therefore no additional rating is recommended.  There were no other conditions within the Board’s scope of review for consideration.  

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20140411, 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 31 May 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 USN
	- XXXXXXXXXXXXXXXXXXXX, former USN
	- XXXXXXXXXXXXXXXXXXXX, former USN
	- XXXXXXXXXXXXXXXXXXXX, former USN
	- XXXXXXXXXXXXXXXXXXXX, former USN
	- XXXXXXXXXXXXXXXXXXXX, former USN
	- XXXXXXXXXXXXXXXXXXXX, former USN
	- XXXXXXXXXXXXXXXXXXXX, former USN
	- XXXXXXXXXXXXXXXXXXXX, former USN

					XXXXXXXXXXXXXXXXXXXX	     				  	Assistant General Counsel
					(Manpower & Reserve Affairs)