RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2014-04022
BRANCH OF SERVICE:  Coast Guard 	SEPARATION DATE:  20020729

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E5, Aviation Structural Mechanic, medically separated for “patellofemoral syndrome, left [knee],” with a disability rating of 0%.  

CI CONTENTION:  The applicant contends his condition continues to worsen and negatively impacts his daily activities.  Additionally, he contends that several conditions (back, diabetes, and PTSD) not previously identified by the MEB or PEB should be rated by the Service.  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 - 20020516	VARD - 20030606	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Patellofemoral Syndrome, Left [Knee]	5299-5003	0%	Patellofemoral Syndrome with Chronic Left Knee Pain	5257	10%	20030415	
COMBINED RATING:  0%	COMBINED RATING OF ALL VA CONDITIONS:  30%	

ANALYSIS SUMMARY:  

Patellofemoral Syndrome, Left [Knee].  According to service treatment records (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI underwent left knee surgery in September 2000 for torn medial meniscus subsequent to an injury.  Following surgery further treatment did not result in improvement sufficient to allow unrestricted duty.  At the time of the orthopedic clinic appointment on 18 September 2001, 1 year after surgery and 10 months before separation, the CI reported intermittent knee pain and swelling.  On examination he was noted to have full range of motion (ROM) with no effusion, tenderness or “maltracking.”  X-rays showed no evidence of osteoarthritis.  The impression was “left knee internal derangement most likely residual meniscal pathology.”  An MRI dated 4 October 2001 showed a “tear of the anterior aspect of the posterior horn of the medial meniscus;” “joint effusion;” and “no evidence of ligamentous injury.”  The CI had chronic knee pain, had been “grounded” (limited duty status) due to his knee condition, and was not considered a surgical candidate.  The MEB forwarded “patellofemoral syndrome” for PEB adjudication.  

The MEB NARSUM examination on 12 March 2002, 4 months before separation, noted “normal ROM” and no effusion.  The patella tracked normally and there were “no areas of point tenderness.”  The CI was taking narcotic pain medication.  Clinic note dated 12 April 2002, noted complaints of constant left knee pain and the CI’s continued use of narcotic pain medication (Percocet 3x/day).  The examiner recorded “minimally altered gait” and addressed medication use.  

At the VA Compensation and Pension (C&P) examination on 15 April 2003, performed 8 months after separation, the CI reported “constant pain in the kneecap,” but denied any locking.  He also reported that his knee had given out on him 4-5 times a year due to pain.  He had “difficulty going up stairs” and couldn’t “do deep knee squats.”  Physical exam showed that he had full extension but flexion was slightly limited to 130 degrees (normal is 140 degrees) with full extension to 0 degrees.  His knee was stable with no ligament laxity and there was no swelling or effusion present.  Testing for meniscal damage was negative.  An MRI in August 2003 documented a meniscal tear with a small joint effusion.  

The Board directed attention to its rating recommendation based on the above evidence.  The PEB rated the left knee condition 0%, coded 5299-5003 (analogous to degenerative arthritis).  The VA rated the left knee condition 10%, coded 5257 (knee, other impairment of: with mild recurrent subluxation or lateral instability), citing “recurrent subluxation or lateral instability of the knee which [was] slight.”  There was no limitation of flexion or extension that supported a rating under the VASRD diagnostic codes for limitation of motion (5260 or 5261).  The examinations proximate to separation did not demonstrate the presence of ligamentous instability or laxity (5257).  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).  

However, the CI had patellofemoral syndrome with prior meniscal surgery as well as post-surgery evidence of a meniscal tear with symptoms and functional loss (based on §4.59, §4.40 and §4.45) for analogous coding under the semilunar cartilage (5258 or 5259).  The Board adjudged that rating analogously to 5259 code (cartilage, semilunar, removal of, symptomatic) was applicable in this case, and warranted a 10% rating.  There was insufficient history of frequent locking with recurrent effusions (5258; analogous to a dislocated meniscus or loose body) to support a higher rating under that code.  

After due deliberation, 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, coded 5299-5259.  

BOARD FINDINGS:  In the matter of the left knee condition, the Board unanimously recommends a disability rating of 10%, coded 5299-5259 IAW VASRD §4.71a.  There were no other conditions within the Board’s scope of review for consideration.  

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	
Left Knee Patellofemoral Syndrome	5299-5259	10%	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20140917, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

Commandant
United States Coast Guard	Mail Stop 7907
2703 Martin Luther King Jr. Ave SE
Washington, DC 20593-7907
Staff Symbol: CG-1
Phone: (202) 475-5000

								   1850

Dear XXXXXXXXXX,
I am the Designated Decision Authority for the Coast Guard on applications submitted to the Department of Defense Physical Disability Board of Review (PDBR).  Under the authority of Title 10, United States Code, section 1554a, I accept the PDBR’s recommendation in your case (Case Number PD-2014-04022) and hereby modify the disability rating previously assigned to reflect a rating of 10% and no re-characterization of your separation.  This decision will be effective as of the date of your prior medical separation.  Please allow up to ninety (90) days for the corrections to be made.

Enclosed for your information are a copy of the PDBR’s recommendation and a copy of the record of proceedings. 

A copy of this decision has also been provided to Coast Guard Enlisted Personnel Management Branch, the PDBR, and the Department of Veterans Affairs. 

If you have any further questions, please contact the Coast Guard Personnel Service Center at (202)795-6645. 
	Sincerely,
2 Enclosures		
	
Copy:	CG Personnel Service Center (EPM-1)
DoD Physical Disability Board of Review
Department of Veterans Affairs