RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2015-00712
BRANCH OF SERVICE:  Navy                                                                   SEPARATION DATE:  20041017

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E4, H-60 Electrical Systems Initial Organizational Maintenance Technician, medically separated for “medial femoral condyle osteochondritis dissecans,” with a disability rating of 10%.

CI CONTENTION:  The CI’s condition continues to worsen. He requested review of all conditions to include conditions not found unfitting. The 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 on 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 - 20040907	VARD - 20050608	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Medial Femoral Condyle Osteochondritis Dissecans	5099-5003	10%	Osteochondritis Dissecans, Medial Femoral Condyle, Right Knee	5010	0%	STR	
Persistent Right Knee Pain	Cat II					
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  0%	

ANALYSIS SUMMARY:  

Medial Femoral Condyle Osteochondritis Dissecans.  According to service treatment records (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI underwent right knee surgery (arthroscopic abrasion chondroplasty of the right medial femoral condyle) in December 2003 for osteochondritis dissecans.  Following surgery further treatment did not result in improvement sufficient to allow unrestricted duty.  The MEB forwarded “medical femoral condyle” for PEB adjudication.  

At the time of the 30 July 2004 orthopedic clinic appointment, 3 months prior to separation, the examiner recorded the CI was 8 months post-surgery and his pain had not resolved.  On examination there was tenderness, no effusion or ligamentous instability and the right knee range of motion (ROM) was “full.” The 9 August 2004 MEB NARSUM, 2 months prior to separation, noted the CI denied any mechanical symptoms, however, he had difficulty running and still had pain, especially with squatting and going up and down stairs.  He denied any neurological complaints.  The MEB physical examination noted well-healed surgery scars.  On examination the right knee ROM was “full” and the gait was normal.  He had tenderness but there was no effusion or ligamentous instability.  The record did not show that the CI attended a VA Compensation and Pension evaluation proximate to separation.  

The Board directed attention to its rating recommendation based on the above evidence.  The PEB rated the right knee condition 10%, coded 5099-5003 (degenerative arthritis). The Navy PEB also listed persistent right knee pain as a related Category II condition (one that contributed to the primary unfitting condition but was not separately ratable).  The VA rated the right knee condition 0%, coded 5010 (arthritis due to trauma) based on the CI’s STR, citing no objective evidence of painful or limited motion because the CI did not attend the scheduled VA exam.  The Board determined that the impairment from the persistent right knee pain was properly subsumed under the overall rating for the medial femoral condyle osteochondritis dissecans IAW §4.14 (avoidance of pyramiding; more than one rating based on the same impairment is prohibited). 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 with functional loss supporting a 10% rating (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 those 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, 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 right knee condition.  

BOARD FINDINGS:  In the matter of the right medial femoral condyle osteochondritis dissecans and persistent right knee pain conditions 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 20150602, 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 23 Mar 17

      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:

		- XXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXX, former USN 
		- XXXXXXXXXXXXXXXXXX, former USMC 
		- XXXXXXXXXXXXXXXXXX, former USN 
		- XXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXX, former USN

						  XXXXXXXXXXXXXXXXXX
	     				  	Assistant General Counsel
                                                                              (Manpower & Reserve Affairs)