RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXXX	CASE:  PD-2014-03411
BRANCH OF SERVICE:  Marine Corps 	SEPARATION DATE:  20090429

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 “grade III focal chondral lesion medial femoral condyle,” with a disability rating of 10%.  

CI CONTENTION:  “Please 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 - 20090211	VARD - 20090818	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Grade III Focal Chondral Lesion Medial Femoral Condyle	5099-5003	10%	Prepatellar Tendonitis, Status Post Right Patellar Tendon Surgery	5260	10%	20090209	
Right Knee Patella Tendinitis Chronic	Cat II					
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  50%	

ANALYSIS SUMMARY:  

Grade III Focal Chondral Lesion Medial Femoral Condyle.  According to service treatment records (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s right knee condition began in June 2007, after jumping off of a military vehicle and hyperextending his knee.  Radiographic imaging showed a distal femoral (focal medial condyle) lesion and a partial patellar tendon tear.  In September 2008 arthroscopy and open debridement of the patellar tendon was performed.  There was no further surgical indications, and conservative treatment did not result in improvement sufficient to allow unrestricted duty.  The MEB forwarded “patellar tendinitis,” and for PEB adjudication.  
The MEB NARSUM was dated 5 December 2008, 5 months pre-separation.  The CI reported inability to run, perform impact activities, or perform with load bearing equipment.  Physical examination showed a normal gait, tenderness of the proximal patellar tendon, and at the medial knee (femoral condyle), “full” flexion and extension (normal), and no evidence of instability, laxity, or meniscal injury.  

At the VA Compensation and Pension (C&P) evaluation dated 9 February 2009, 3 months pre-separation, the CI reported occasional wear of a brace and constant anterior knee pain exacerbated by physical activity and cold weather.  He denied impact on vacuuming, gardening, driving, and mowing the lawn.  Physical examination showed a normal gait, full flexion and extension, patellar tenderness, and no evidence of effusion, crepitus, locking, or instability.  Range of motion (ROM) was 0-135 degrees (normal 0-145).  Radiographic imaging documented normal bony alignment of the femur and patella, normal joint spaces, and no structural abnormalities, bone spurs, or erosions.  

The Board directed attention to the rating recommendation based on the above evidence.  The PEB rated 10% for the “grade III focal chondral lesion [of the] medial femoral condyle” and related Category II diagnosis (“right knee patella tendinitis chronic”), analogously coded 5099-5003 (degenerative arthritis).  The VA rated 10% for the “prepatellar tendonitis, status post right patellar tendon surgery,” coded 5260 (leg, limitation of flexion), citing functional impairment and limitation of motion with pain.  The PEB listed the “grade III focal chondral lesion [of the] medial femoral condyle,” and also listed the “right knee patella tendinitis chronic” as a related Category II diagnosis contributing to the disability in this case.  The Board concluded the Category II diagnosis was not a separate condition which could be reasonably justified as separately unfitting; nor would separate ratings be achievable without violation of VASRD §4.14 (avoidance of pyramiding).  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.  There was no limitation of motion which supported a higher rating under the diagnostic codes for limitation of flexion or extension (5260, 5261).  There was no evidence of instability, or meniscal lesion for coding under 5257, 5258, or 5259.  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.  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 “grade III focal chondral lesion medial femoral condyle,” condition.  

BOARD FINDINGS:  In the matter of the “grade III focal chondral lesion medial femoral condyle,” 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 20140708, 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 6 Jul 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 USN
		- XXXXXXXXXXXXXXXXXXXX, former USMC
		- XXXXXXXXXXXXXXXXXXXX, former USMC
		- 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 USMC

						  	XXXXXXXXXXXXXXXXXXXX
	     				  		Assistant General Counsel
						  	(Manpower & Reserve Affairs)