RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2015-01233
BRANCH OF SERVICE:  Navy 	SEPARATION DATE:  20030425

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E5, Builder, medically separated for “chronic patellofemoral syndrome (left),” with a disability rating of 10%.  

CI CONTENTION:  “Review 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 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 - 20030109	VARD - 20030620	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Patellofemoral Syndrome, Left Knee	5299-5003	10%	Patellofemoral Syndrome, Left Knee	5299-5003	10%	20030402	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  30%	

ANALYSIS SUMMARY:  

Chronic Patellofemoral Syndrome, Left Knee.  According to the service treatment record (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s chronic left knee pain began approximately in 1992, became worse starting in the spring of 2000 and continued getting progressively worse.  No injury was described.  There was no surgical indication.  Despite conservative treatments, the left knee condition could not be adequately rehabilitated to meet the physical requirements of the CI’s military specialty and the CI was referred for MEB.  The MEB forwarded “chronic patellofemoral syndrome” for PEB adjudication.  Magnetic resonance studies of the left knee completed on 4 April 2002 showed intra-substance degenerative change of the anterior horn of the lateral meniscus and the posterior horn of the medial meniscus that was worse in comparison to the 27 July 2000 study.  Chondromalacia patella also appeared worse.  

The 21 October 2002 MEB NARSUM examination, 6 months prior to separation, noted complaints of increasing left knee pain for the last year despite conservative management which included anti-inflammatories, rest and physical therapy (PT).  Prolonged sitting, standing and kneeling caused “excruciating” pain.  The physical examination showed full range of motion (ROM).  There was patellar grind and a positive popliteal angle of 45 degrees (tight hamstrings), some tilting of the lateral patella and pain with compression.  At the 2 April 2003 VA Compensation and Pension (C&P) examination, performed less than 1 month before separation, the CI reported pain with walking and limited ability to kneel with exacerbations.  The physical examination showed a normal posture and gait.  Left knee ROM was flexion 140 degrees (normal 140) and extension 0 degrees (normal 0).  There was no pain, fatigue, weakness, lack of endurance or incoordination.  There was no evidence of recurrent subluxation, locking pain, joint effusion or crepitus.  

The Board directed attention to its rating recommendation based on the above evidence.  The PEB rated the left knee pain condition 10%, analogously coded 5299-5003 (arthritis, degenerative).  The VA also rated the left knee condition 10% analogously coded 5299-5003, based on the VA C&P examination less than 1 month before separation, citing painful or limited motion of a major joint or group of minor joints.  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 minimal compensable rating of 10% (based on §4.59, §4.40 and §4.45) as adjudicated by the PEB and VA.  There was no history of dislocated meniscus or loose body causing frequent locking with recurrent effusions (5258) or history of surgery to remove a meniscus (5259) 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 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 left knee condition.  

BOARD FINDINGS:  In the matter of the left 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 modification or re-characterization of the CI’s disability and separation determination.  

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20150614, 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 25 Apr 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 USN
		- XXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXX, former USMC
		- XXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXX, former USMC 
		- XXXXXXXXXXXXXXXXXX, former USN 
		- XXXXXXXXXXXXXXXXXX, former USN 
		- XXXXXXXXXXXXXXXXXX, former USMC
		- XXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXX, former USMC
		- XXXXXXXXXXXXXXXXXX, former USMC
		- XXXXXXXXXXXXXXXXXX, former USMC