RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2014-02487
BRANCH OF SERVICE:  Navy 	SEPARATION DATE:  20021002

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an activated Reserve E4, Engineman, medically separated for “bilateral patellofemoral syndrome” with a disability rating of 10%.  

CI CONTENTION:  The CI requests the Board consider all 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 based upon a 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 - 20020806	VARD - 20021008	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Bilateral Patellofemoral Syndrome	5299-5003	10%	Chondromalacia, Left Knee	5299-5262	10%	20020612	
			Chondromalacia, Right Knee	5299-5262	10%		
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  20%	

ANALYSIS SUMMARY:  

Bilateral Patellofemoral Syndrome.  According to service treatment records (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s bilateral knee condition began in began in June of 2000 while in recruit training.  At an orthopedic clinic visit in March 2002, she was diagnosed with bilateral patellofemoral syndrome.  Despite treatment, the bilateral knee condition could not be adequately rehabilitated to meet the physical requirements of the CI’s military specialty and an MEB referral was made.  The MEB forwarded “bilateral patellofemoral syndrome” for PEB adjudication.  

At the MEB NARSUM examination on 21 March 2002, (7 months pre-separation), the CI reported pain with walking, maneuvering stairs, and with prolonged sitting.  The examiner documented a non-antalgic gait, poor thigh muscle tone, and no guarding.  Bilaterally, there was no effusion, and no evidence of ligamentous instability or meniscal pathology.  Both knees tested positive for patellofemoral syndrome (i.e. pain with lateral compression and patellar grind), with additional crepitus and “more acute” findings on the left.  Bilateral range of motion was from 0-140 degrees (normal).  

At the 12 June 2002, VA Compensation and Pension (C&P) evaluation (4 months pre-separation), the CI reported left knee pain with walking and prolonged sitting, and the left knee gave way once or twice per week.  The examiner documented bilateral range of motion of 0-135 degrees, with “2+” crepitus bilaterally, and bilateral patellar subluxation on full extension.  There was no evidence of swelling or tenderness, painful motion or weakness; and no evidence of ligamentous instability or meniscal pathology.  Radiographic evaluation documented no abnormalities with normal patellar tracking.  

The Board directed attention to the rating recommendation based on the above evidence.  The PEB rated the bilateral knee condition 10% analogously coded 5299-5003, (arthritis, degenerative), stated that the condition was pre-existing, and reduced it by 0%.  The VA rated the left and right knee chondromalacia at 10% each, analogously coded 5262 (tibia and fibula, impairment of), citing slight right and left knee disability.  The Board concluded there was not a preponderance of evidence in the STR which overcame the presumption that the bundled knee condition was reasonably considered separately unfitting.  

The Board then considered the rating recommendation for the unfitting knee conditions at the time of separation.  There was no limitation of motion which supported a rating under the diagnostic codes for limitation of flexion or extension (5260, 5261) for either knee; however, there was evidence of painful motion, crepitus, with functional loss supporting a 10% rating for each knee (based on §4.59, §4.40 and §4.45).  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 no VASRD §4.71a route to a rating higher than the 10% for each knee 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 recommends a disability rating of 10% for the left knee condition, and 10% for the right knee condition analogously coded 5299-5262.  

BOARD FINDINGS:  In the matter of the bilateral knee condition, the Board unanimously recommends that each joint be separately adjudicated as follows: an unfitting right knee and an unfitting left knee condition, both separately rated 10%, and both analogously coded 5299-5262 and IAW VASRD §4.71a.  The Board recommends that the CI’s prior determination be modified as follows, effective as of the date of the prior medical separation:  

CONDITION	VASRD CODE	PERMANENT RATING	
Chondromalacia, Left Knee	5299-5262	10%	
Chondromalacia, Right Knee	5299-5262	10%	
COMBINED (w/BLF)	20%	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20140529, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

MEMORANDUM FOR COMMANDER, NAVY PERSONNEL COMMAND
	         DEPUTY COMMANDANT, MANPOWER & RESERVE AFFAIRS	
	                          
Subj:  PHYSICAL DISABILITY BOARD OF REVIEW (PDBR) RECOMMENDATIONS          

Ref:  (a) DoDI 6040.44
	(b) PDBR ltr dtd 31 May 16 ICO XXXXXXXXXXXXXXXXXX
	(c) PDBR ltr dtd 6 Jun 16 ICO XXXXXXXXXXXXXXXXXX
	(d) PDBR ltr dtd 7 Jun 16 ICO XXXXXXXXXXXXXXXXXX
	(e) PDBR ltr dtd 27 May 16 ICO XXXXXXXXXXXXXXXXXX
	(f) PDBR ltr dtd 31 May 16 ICO XXXXXXXXXXXXXXXXXX
	(g) PDBR ltr dtd 7 Jun 16 ICO XXXXXXXXXXXXXXXXXX

1.  Pursuant to reference (a), the recommendations of the Physical Disability Board of Review set forth in references (b) through (g) are approved.

2.  The official records of the following individuals are to be corrected to reflect the stated disposition:

     a. XXXXXXXXXXXXXXXXXX, former USMC: Entitlement to disability separation pay with a 20 percent disability rating (increased from 10 percent) effective date of discharge.

     b. XXXXXXXXXXXXXXXXXX, former USMC: Entitlement to disability separation pay with a 20 percent disability rating (increased from 10 percent) effective date of discharge.

     c. XXXXXXXXXXXXXXXXXX, former USN: Entitlement to disability separation pay with a 10 percent disability rating (increased from 0 percent) effective date of discharge.
     
     e. XXXXXXXXXXXXXXXXXX, former USN: Retroactive placement on the Permanent Disability Retired List with a 30 percent disability rating (increased from 10 percent) effect date of discharge.

     f. XXXXXXXXXXXXXXXXXX, former USMC: Entitlement to disability separation pay with a 20 percent disability rating (increased from 10 percent) effective date of discharge.

     g. XXXXXXXXXXXXXXXXXX, former USN: Entitlement to disability separation pay with a 20 percent disability rating (increased from 10 percent) effective date of discharge.

3.  Please ensure all necessary actions are taken to implement these decisions, including the recoupment of disability severance pay, if warranted, and notification to the subject members once those actions are complete.