RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXXX 	CASE:  PD-2014-03627
BRANCH OF SERVICE:  Navy 	SEPARATION DATE:  20040216

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty, E3, Air Traffic Controlman, medically separated for “chronic patellofemoral chondrosis of the right knee,” 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 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 - 20031106	VARD - 20040713	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Patellofemoral, Right Knee	5299-5003	10%	Residuals, Right Knee Injury with DJD	5010-5260	10%	20040616	
RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  50%	

ANALYSIS SUMMARY:  

Right Knee Patellofemoral Chondrosis.  According to service treatment records and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s right knee condition began in September of 2002 following direct trauma at boot camp.  Magnetic resonance imaging demonstrated patellar articular cartilage fissuring and a cartilage flap.  Arthroscopy in January 2003 revealed Grade 1 to Grade 2 chondrosis of the patellar articular surface, and the CI underwent drainage of post-operative effusion.  Despite treatment, the CI’s knee condition could not be adequately rehabilitated to meet the physical requirements of the CI’s military specialty and was referred for an MEB.  The range of motion (ROM) 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.  

Right Knee ROM
(Degrees)	MEB ~9 Mo. Pre-Sep	Primary Care ~3 Mo. Pre-Sep	VA C&P ~4 Mo. Post-Sep	
Flexion (140 Normal)	90	120	110	
Extension (0 Normal)	0		Full	
Comment:  Surgery 
~ 13 Mo. Pre-Sep	Painful motion, tenderness	Antalgic gait, crepitus, tenderness, muscle strength 4/5, see text	Normal gait, painful motion, slight swelling, tenderness over patella, “some” quads wasting	
§4.71a Rating	10%	10%	10%	

At the NARSUM examination dated 28 May 2003 (9 months prior to separation) the CI reported persistent knee pain and lack of motion.  The MEB physical exam noted tenderness almost globally and along the borders of the patella.  There was no effusion instability or laxity (negative Lachman and varus and valgus stress).  At the primary care clinic examination dated 4 November 2003 (3 months prior to separation) the CI reported that 3 days prior his right knee gave out and then swelled.  There was pain limited ROM with exam findings summarized above.  Meniscal signs and laxity signs were mixed with positive and negative findings (positive Apley’s), Flicks and Valgus stress; negative McMurray, Lachman, draws, and Varus stress).

At the VA Compensation and Pension (C&P) General examination dated 16 June 2004 (4 months after separation) the CI reported that he could not bend or walk for more than 5 minutes.  Physical exam showed flexion limited due to pain and stiffness.  There were no meniscal signs or indications of laxity (negative McMurray, no joint line tenderness, negative drawer).  

The Board directed attention to its rating recommendation based on the above evidence.  There was no limitation of motion which attains a minimum rating under the diagnostic codes for limitation of flexion or extension and neither the Service nor VA evidence indicated the presence of frequent locking with effusions (or any indication of dislocated meniscus or loose body-code 5258).  The single exam documenting any indication of meniscal signs, ligamentous instability or laxity showed mixed testing results and was following an acute injury.  There was no evidence of laxity or indication of dislocated meniscus or loose body in the subsequent VA exam.  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 and subsequently the VA.  Alternate coding under analogous code 5259 (symptomatic meniscus – semilunar cartilage removal), includes painful motion and would rate no higher than 10%.  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 knee condition.  

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.  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 20131015, 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 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)