RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2015-01457
BRANCH OF SERVICE:  Navy 	SEPARATION DATE:  20080928

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E5, Fire Controlman, medically separated for “probable mild patellofemoral joint arthritic change,” with a disability rating of 10%.

CI CONTENTION:  The conditions continue to worsen.  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 - 20080403	VARD - 20141210	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Probably Mild Patellofemoral Joint Arthritic Change	5099-5003	10%	Status Post Cartilage Restoration Surgery, Left Knee	5259	10%	20141210	
Question Erosion or Injury Along the Articular Surface of the Medial Facet of the Patella	Not Unfitting / Cat II					
Left Knee Trochlea Osteochondral Defect Status Post Microfracture	Not Unfitting / Cat II					
Small Effusion	Not Unfitting / Cat II					
		Surgical Scars, Status Post Cartilage Restoration Surgery, Left Knee	7802	0%	20141210	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  30%	

ANALYSIS SUMMARY:  

Probable Mild Patellofemoral Joint Arthritic Change.  According to service treatment records (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s left knee condition began in April 2007 after twisting his knee while playing basketball.  Diagnostic imaging studies (X-ray) 25 April 2007 showed no fractures with positive effusion.  
 Left knee arthroscopy surgery was performed 2 August 2007 where a loose body was removed and an osteochondral lesion in the lateral trochlea was found.  Following surgery further treatment did not result in improvement sufficient to allow unrestricted duty.  

During the MEB examination (recorded on DD Forms 2807 and 2808) dated 12 March 2008, 6 months prior to separation, the CI reported significant left knee pain that prevented him from negotiating stairs or steps, running or jumping.  Physical examination showed well-healed arthroscopic incisions with no effusion, swelling, erythema, or cellulitis.  There was no tenderness about the arthroscopic incisions but there was moderate tenderness to deep palpation of the lateral patellofemoral joint along the trochlea.  There was positive patellar grind and an abnormal gait.  Examination tests for ligamentous instability and meniscus pathology were negative.  Range of motion (ROM) testing recorded 134 degrees flexion (140 normal) without pain, and 0 degrees extension (normal).

At the 3 November 2014 VA Compensation and Pension (C&P) evaluation, performed 6 years and 1 month after separation, the CI reported left knee pain with exertion and prolonged activity.  Physical examination showed normal strength and examination tests for ligamentous instability and meniscus pathology were negative.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the left knee condition 10%, coded 5099-5003 (arthritis, degenerative (hypertrophic or osteoarthritis)).  The Board agreed that the three additional Category II conditions (conditions which contributed to the primary unfitting condition but were not separately ratable) were intertwined diagnoses, and the overall knee impairment from all listed diagnoses were properly subsumed under the ratings for the knee by the PEB.  More than one rating based on the same impairment is prohibited, IAW §4.14 (avoidance of pyramiding).  The panel agreed the VA examination was too remote from separation and therefore lacked probative value.

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.  The examinations proximate to separation did not demonstrate the presence of ligamentous instability or laxity (5257).  The 5259 code (cartilage, semilunar, removal of, symptomatic) was applicable in this case but the maximum 10% rating under that code provided no benefit to the CI.  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 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 re-characterization of the CI’s disability and separation determination.  

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20150617, with attachments
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