RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2015-01360
BRANCH OF SERVICE:  Navy 	    SEPARATION DATE:  20030411

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an  E4, Construction Mechanic, medically separated for “right [knee] moderate to severe chondromalacia patellae” with a disability rating of 10%.

CI CONTENTION:  The CI made no specific contention.  The complete submission is at Exhibit A.  

SCOPE OF REVIEW:  The panel’s scope of review is defined in DoDI 6040.44.  It is limited to review of disability ratings assigned 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 or non-compensable.  Any conditions outside the panel’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 panel’s authority is limited to assessing the fairness and accuracy of PEB rating determinations and recommending corrections, where appropriate.  The panel’s assessment of the PEB rating determination 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(s) at the time of separation.  The panel 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 panel 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 - 20030314	VARD - NA	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Right [Knee] Moderate to Severe Chondromalacia Patellae	5299-5003	10%	No VA Exam in Evidence	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  NA	

ANALYSIS SUMMARY:  

Right Moderate to Severe Chondromalacia Patellae.  According to the service treatment record (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s right knee condition began prior to enlistment.  At an 8 July 2002 primary care clinic appointment the CI reported recurrent right knee pain that began as a child.  Magnetic resonance imaging in August 2002 showed chondromalacia patellae (inflammation and softening of kneecap cartilage) with joint effusion, and a discoid meniscus (normal anatomical variant) without evidence of a meniscal tear.  There was no surgical indication.  At the ortho major clinic appointment on 30 July 2002, range of motion (ROM) was flexion of 130 degrees (140 normal) and extension of 0 degrees (0 normal) with effusion noted.  At the 11 September 2002 physical therapy examination, 7 months prior to separation, the CI reported right knee pain that prevented running and it was aggravated with stairclimbing.  She reported no pain at the time of the examination.  The examiner noted that her ROM was within normal limits, but her right knee appeared to be lacking 3 degrees of extension due to swelling.  At the 22 October 2002 orthopedic clinic appointment, 6 months prior to separation, the CI reported occasional popping and locking pain at the medial aspect of the right knee.  She also reported a single episode of significant swelling after dancing three weeks earlier.  On examination her ROM was extension lacking 5 degrees and flexion of 135 degrees.  She had mild effusion and medial joint line tenderness, but no crepitus.  Tests for ligamentous instability and meniscal pathology were negative.  There was moderate medial and lateral patella displacement.  At the 3 December 2002 orthopedic clinic visit, the examiner noted significant patellofemoral pain and crepitus and surgical options for the right knee chondromalacia patella were discussed but the CI opted for a MEB.

The 3 December 2002 MEB NARSUM, 4 months prior to separation, noted the majority of the CI’s pain was around the patella and there was pain with patellar stability testing.  Tests for ligamentous instability and meniscal pathology were negative.  The examination was silent in regards to ROM.  

During the 9 April 2003 MEB examination (recorded on DD Forms 2807-1 and 2808), 4 days prior to separation, the CI reported that she wore a knee brace for her knee problems.  Physical examination showed crepitus and minimal tenderness to palpation of the knee.  There were no other pertinent findings in this examination.

There was no VA examination in evidence proximate to separation.

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the right knee condition 10%, coded 5299-5003 (analogous to degenerative arthritis). 
There was no limitation of motion which supported a rating under the diagnostic codes for limitation of flexion or extension (5260, 5261).  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 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 panel 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 knee condition and IAW VASRD §4.71a, the panel unanimously recommends no change in the PEB adjudication.  There are no other conditions within the panel’s scope of review for consideration.  

The panel, 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 20150616, 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: PHYSICIU. DISABILITY BOARD OF REVIEW (PDBR) RECOMMENDAT IONS Ref:	(a) DoDI 6040.44
In accordance with reference (a), I have reviewed the cases listed below and 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 USMC
-	
XXXXXXXXXXXXXXXXXX,former USN