RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2014-01800
BRANCH OF SERVICE:  MARINE CORPS	SEPARATION DATE:  20020328

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty, E5, Machine Gunner, medically separated for “chronic left knee pain secondary to chondromalacia patella,” with a disability rating of 10%.  

CI CONTENTION:  The CI requests the Board consider all conditions.  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 - 20011228	VARD - 20070917	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Left Knee, Chondromalacia Patella	5299-5003	10%	Left Knee Condition	5257	NSC	STR	
Chondromalacia, Lateral Tibial Plateau	Cat II					
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  NSC	

ANALYSIS SUMMARY:  

Chronic Left Knee Pain Secondary to Chondromalacia Patella.  According to service treatment records and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s left knee symptoms were first noted in January 2000 with a twisting incident while running and hitting his knee on the deck.  Numerous other incidents involving the knee were recorded.  Magnetic resonance imaging completed in January 2001 was reported as normal.  He was unresponsive to physical therapy and underwent arthroscopic chondroplasty on 31 July 2001.  Findings of the surgery showed grade III chondromalacia of the patella and grade II chondromalacia changes of his trochlea with significant fissuring of his lateral tibial plateau.  Normal meniscus and anterior/posterior cruciate ligaments were noted.  At the time of the orthopedic clinic appointment on 21 September 2001, the CI was doing better, but still had symptoms.  Physical exam noted no effusion, full range-of-motion, minimal crepitus and tenderness to palpation.  The MEB NARSUM performed on 2 November 2001, (4 months prior to separation) noted a long history of worsening left knee pain.  Pain was aggravated by running, going up and down stairs and sitting for prolonged periods of time.  Physical exam showed a normal gait, full range-of-motion with no effusion.  He was tender to palpation in his medial and lateral facets and had pain when his patella was blocked with quad contraction.  He still had pain with prolonged sitting and going up two flights of stairs.  He was unable to run without pain.  

The CI did not present for a VA Compensation and Pension examination until 26 September 2011 (over 9 years remote from separation).  

The Board directed attention to its rating recommendation based on the above evidence.  The PEB assigned a 10% rating under an analogous code 5299-5003 (arthritis, degenerative), citing knee pain.  The VA non-service connected (NSC) the left knee condition citing lack of evidence showing a current disability of the left knee (remote VA rating was 10% coded 5260 effective in 2011).  There was no evidence of 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), or history of surgery to remove a meniscus (5259) 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.  

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:  In the matter of the left knee condition and IAW VASRD §4.71a, 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 20140416 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 12 Apr 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:

		- XXXXXXXXXXXXXXX, former USMC
		- XXXXXXXXXXXXXXX, former USMC
		- XXXXXXXXXXXXXXX, former USMC
		- XXXXXXXXXXXXXXX, former USMC 
		- XXXXXXXXXXXXXXX, former USMC
		- XXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXX, former USMC
		- XXXXXXXXXXXXXXX, former USMC
		- XXXXXXXXXXXXXXX, former USMC