RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXXX	CASE:  PD-2014-02325
BRANCH OF SERVICE:  Marine Corps 	SEPARATION DATE:  20080215

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E3, Rifleman, medically separated for “left patellar dislocation,” with a disability rating of 10%.

CI CONTENTION:  The applicant contends for left knee and PTSD conditions.  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:  

SERVICE PEB - 20071129	VARD - 20080527	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Left Patellar Dislocation	5299-5003	10%	Residual S/P Left Knee Surgery, Patellofemoral Syndrome	5299-5261	0%	20080327	
Status Post Left Patellar Stabilization and Reefing, Lateral Release	Not Unfitting , Category II					
Patellar Chondroplasty and Medical Meniscus Repair						
Patellar Chondromalacia with Medial Meniscus Tear						
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  0%	

ANALYSIS SUMMARY:  

Left Patellar Dislocation.  According to service treatment records (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI had a history of left knee pain and injured his left knee in May 2006 performing martial arts.  Diagnostic imaging (X-ray) studies on 24 May 2006 showed a medical collateral ligament injury (Pellegrini-Stieda syndrome).  
There was normal assessment of the joint surfaces of the left knee.  Arthroscopic patellar stabilization and medial retinacula reefing with a medial meniscus repair, lateral release and patellar chondroplasty surgery was performed 29 January 2007.  Following surgery further treatment did not result in improvement sufficient to allow unrestricted duty.  The MEB forwarded “dislocation of patella, closed,” “chondromalacia of patella,” “other joint derangement, not elsewhere classified, lower leg,” and “pain in joint involving lower leg,” for PEB adjudication.  During the MEB examination dated 5 September 2007, 5 months prior to separation, the CI reported left knee patellar instability that only allowed him to run 1½ miles without pain.  He reported his patellar stability decreased due to fatigue during therapy and he wore braces which provided relief from the knee pain, but he still experienced pain with deep squats.  Physical examination showed positive patellar grind and crepitus with pain.  There was full active ROM.  There was no patellar apprehension, however, there was increased patellar mobilization laterally.  At the 27 March 2008 VA Compensation and Pension (C&P) evaluation, performed 1 month after separation, the CI reported daily left knee pain that increased navigating stairs and walking long distances.  He reported buckling of the knee but no locking or instability.  The pain did not interfere with his job but affected his daily activities to include limiting walking and participation in sports.  Physical examination showed no instability or swelling and normal strength.  The patellar grind test was positive and there was positive medial joint line tenderness.  Examination tests for ligamentous instability and meniscus pathology were negative.  There was normal ROM.  

The Board directed attention to its rating recommendation based on the above evidence.  The PEB rated the left knee condition 10% coded 5299-5003 (Arthritis, degenerative, hypertrophic or osteoarthritis).  The Navy PEB also listed status post left patellar stabilization and reefing, lateral release, patella chondroplasty and medical meniscus repair, patellar chondromalacia with medial meniscus tear as related Category II conditions (conditions that contributed to the primary unfitting condition but were not separately ratable).  The impairment from the status post left patellar stabilization and reefing, lateral release, patella chondroplasty and medical meniscus repair, patellar chondromalacia with medial meniscus tear were properly subsumed under the overall rating for the left patellar dislocation IAW §4.14 (avoidance of pyramiding; more than one rating based on the same impairment is prohibited).  The VA rated the left knee condition 0% coded 5299-5261 (Leg, limitation of extension of), citing no objective evidence of painful or limited motion of a major joint or group of minor joints, or multiple joint involvement.  There was no limitation of motion which supported a rating under the diagnostic codes for limitation of flexion or extension (5260, 5261).  However, there was evidence of painful motion 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), and there was no history of dislocated meniscus or loose body causing frequent locking with recurrent effusions (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 was 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, and 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 patellar dislocation condition.

BOARD FINDINGS:  In the matter of the left patellar dislocation 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 20140528, with attachments
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 24 Jun 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 USMC
		- XXXXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXXXX, former USMC
		- XXXXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXXXX, former USMC
		- XXXXXXXXXXXXXXXXXXXX, former USMC
		- XXXXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXXXX, former USMC 

						XXXXXXXXXXXXXXXXXXXX
	     				  	Assistant General Counsel
						(Manpower & Reserve Affairs)