RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXX	CASE:  PD-2015-01245
BRANCH OF SERVICE:  Navy 	SEPARATION DATE:  20020531

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E6, Fire Control Technician, medically separated for “right knee patellofemoral syndrome,” with a disability rating of 10%.  

CI CONTENTION:  “Pain has increased.  Abilities to have normal life have decreased.”  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 - 20020204	VARD - 20030110	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Right Knee Patellofemoral Syndrome	5299-5003	10%	Chondromalacia Patella, Right Knee	5299-5257	10%	20021121	
			Surgical Scar, Right Knee	7804	10%		
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  20%	

ANALYSIS SUMMARY:  

Right Knee Patellofemoral Syndrome.  According to the service treatment record (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI underwent right knee arthroscopic surgery with lateral release in May 2000 for right knee chondromalacia.  Following surgery further treatment did not result in improvement sufficient to allow unrestricted duty. The MEB forwarded “right knee patellofemoral syndrome, unresolved” for PEB adjudication.  The physical therapy (PT) clinic examination on 30 July 2001, 15 months post-surgery and 10 months prior to separation, noted complaints of pain at 5/10 on a scale of 0-10 (0= no pain; 10 = maximum pain).  The physical examination recorded full active range of motion (FAROM) and a normal gait.  
The 9 October 2001 orthopedic MEB NARSUM examination, 17 months post-surgery and 8 months prior to separation, noted complaints of anterior knee pain (improved somewhat).  There was no catching, popping, or giving way with pivot maneuvers.  The CI claimed to have occasional giving way secondary to anterior knee pain.  There was no locking.  There was occasional swelling.  The CI had difficulty going up and down ladders, and standing or squatting for prolonged periods.  Physical examination showed minimal effusion about the right knee.  ROM was 130 degrees of flexion and 0 degrees of extension.  During the November 2001 MEB examination (recorded on DD Forms 2807 and 2808) 18 months post-surgery and 7 months prior to separation, the physical exam showed atrophy in the CI’s right leg muscles and tenderness medially about the right knee.  At the subsequent and final orthopedic MEB NARSUM examination on 16 January 2002, 20 months after surgery and 5 months prior to separation, the CI continued to have diffuse knee pain, particularly anteriorly.  There was no catching, popping or give way with pivot maneuvers. The CI described buckling, secondary to pain.  There was occasional swelling and no locking. Physical examination showed significant quadriceps atrophy.  ROM measurements were similar to the orthopedic NARSUM.  

At the 21 November 2002 VA Compensation and Pension (C&P) evaluation, performed 6 months after separation, the CI reported anterior right knee pain and occasional swelling around the knee cap.  Pain occurred with standing more than 15 minutes, sitting more than 35 minutes, and walking more than 1-1/2 blocks.  Pain caused occasional awakening, and would occur without a specific aggravating factor.  Kneeling, arising from a squat, ascending and descending stairs increased the pain.  The CI experienced a sensation of instability on one occasion.  No locking or giving way was reported.  The CI had a knee brace which he did not use as it provided no help and he used no other assistive devices for ambulation.  He had lost three days from work over the last year due to his right knee condition.  Physical examination showed the CI had a right antalgic gait.  Diffuse tenderness was noted in the peripatellar region.  Active ROM testing results were recorded were within normal limits accompanied by an antalgic gait, tenderness and painful motion.  Tests for meniscal damage were negative.  

The Board directed attention to its rating recommendation based on the above evidence.  The PEB rated the right knee condition 10%, analogously coded 5299-5003 (arthritis, degenerative).  The VA also rated the right knee condition 10% analogously coded 5299-5257 (knee, other impairment of: recurrent subluxation or lateral instability, slight), based on the VA C&P examination 6 months after separation, citing physical findings per above.  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) as adjudicated by the PEB.  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.  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 patellofemoral syndrome.  

BOARD FINDINGS:  In the matter of the right knee patellofemoral syndrome 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 re-characterization of the CI’s disability and separation determination.  

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20150601, 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:

		- XXXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXXX, former USMC
		- XXXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXXX, former USMC 
		- XXXXXXXXXXXXXXXXXXX, former USN 
		- XXXXXXXXXXXXXXXXXXX, former USN 
		- XXXXXXXXXXXXXXXXXXX, former USMC
		- XXXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXXX, former USMC
		- XXXXXXXXXXXXXXXXXXX, former USMC
		- XXXXXXXXXXXXXXXXXXX, former USMC