RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2015-01508
BRANCH OF SERVICE:  Navy	SEPARATION DATE:  20020816

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E5, Electronics Technician, medically separated for “left knee grade 4 chondromalacia of the medial femoral condyle and trochlear” with a disability rating of 10%.

CI CONTENTION:  Current condition supports a higher rating.  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 - 20020426	VARD - 20020921	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Grade 4 Chondromalacia of the Medial Femoral Condyle and Trochlea	5299-5003 	10%	Status Post Left Knee Arthroscopy and Debridement	5257	20%	20020426	
Varus Gonarthrosis of the Left Knee Status Post Subtotal Medial Meniscectomy	Cat II					
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  30%	

ANALYSIS SUMMARY:  

Left Knee Chondromalacia.  According to the service treatment record (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI underwent in underwent two surgeries (arthroscopes) on the left knee with partial medial meniscectomies (cartilage removal).  Radiographic studies showed varus alignment (bowed leg) and mild medial and patellofemoral degenerative joint disease.  Surgery to correct the varus alignment, including cartilage transplant, was recommended.

At the 27 February 2002 MEB NARSUM examination, 5 weeks postoperative and 6 months before separation, the physician stated “he [CI] continues to regain motion and strength in the left knee.”  Physical examination noted well-healed surgical scars, no tenderness, and range of motion (ROM) was flexion to 90 degrees (normal 140) and extension to 5 (normal 0); painful motion was not addressed.

At the 26 April 2002 VA Compensation and Pension (C&P) evaluation, performed 4 months before separation, the CI reported chronic left knee locking and give way, associated with chronic effusion and swelling and pain.  Physical examination showed tenderness, effusion, and signs of meniscus (semi-lunar cartilage) pathology.  The ROM was flexion to 110 degrees and extension to 0 with painful motion.

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the left knee condition 10%, analogously coded 5003 (degenerative arthritis).  Varus gonarthrosis was also adjudicated as a Category II condition that contributed to the unfitting left knee condition.  The VA rated the left knee condition 20%, coded 5257 (knee, other impairment of: recurrent subluxation or lateral instability), citing evidence of left knee painful-limited ROM, patella tenderness and mild to moderate effusion, with the additional finding of left knee instability.

The Panel deliberated and determined that the PEB’s Category II varus gonarthrosis condition was subsumed under the unfitting left knee condition as pain and if rated separately would be in violation of pyramiding IAW §4.14 (avoidance of pyramiding).

The panel adjudged that the pre-separation VA examination was further from the post-surgical period and closer to separation, and had the highest probative value for rating at separation.  The 5258 code (cartilage, semilunar, dislocated, with frequent episodes of “locking,” pain, and effusion into the joint) was applicable in this case as the VA examination documented both historical and physical examination findings consistent with analogous code 5258 rated at 20%.  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), and no other VASRD §4.71a route to a rating higher than the 20%.

After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the panel recommends a disability rating of 20% for the left knee condition, coded 5003-5258.

BOARD FINDINGS:  In the matter of the left knee condition, the panel unanimously recommends a disability rating of 20%, coded 5003-5258 IAW VASRD §4.71a.  There were no other conditions within the panel’s scope of review for consideration.  The panel recommends that the CI’s prior determination be modified as follows, effective as of the date of the prior medical separation:

CONDITION	VASRD CODE	PERMANENT RATING	
Grade 4 Chondromalacia of the Medial Femoral Condyle and Trochlea (With Varus Gonarthrosis of the Left Knee Status Post Subtotal Medial Meniscectomy)	5003-5258	20%	

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 DEPUTY COMMANDANT, MANPOWER & RESERVE AFFAIRS
		   COMMANDER, NAVY PERSONNEL COMMAND	
	                          
Subj:  PHYSICAL DISABILITY BOARD OF REVIEW (PDBR) RECOMMENDATIONS          

Ref:  (a) DoDI 6040.44
	(b) PDBR ltr dtd 23 May 17 XXXXXXXXXXXXXXXXXX 
	(c) PDBR ltr dtd 26 May 17 XXXXXXXXXXXXXXXXXX
	(d) PDBR ltr dtd 15 Jun 17 XXXXXXXXXXXXXXXXXX 
	(e) PDBR ltr dtd 08 Jun 17 XXXXXXXXXXXXXXXXXX
      (f) PDBR ltr dtd 16 May 17 XXXXXXXXXXXXXXXXXX

1.  Pursuant to reference (a), the recommendations of the Physical Disability Board of Review set forth in references (b) through (f) are approved.  The official records of the following individuals are to be corrected to reflect the stated disposition below:

     a. XXXXXXXXXXXXXXXXXX, former USMC: Placement on the Permanent Disability Retired List with a 30 percent rating (increased from 10 percent) effective date of discharge.

     b. XXXXXXXXXXXXXXXXXX, former USMC: Entitlement to disability separation pay with a 20 percent disability rating (increased from 10 percent) effective date of discharge.

     c. XXXXXXXXXXXXXXXXXX, former USN: Entitlement to disability separation pay with a 20 percent disability rating (increased from 10 percent) effective date of discharge.

     d. XXXXXXXXXXXXXXXXXX, former USMC: Placement on the Permanent Disability Retired List with a 30 percent rating (increased from 10 percent) effective date of discharge.

     e. XXXXXXXXXXXXXXXXXX, former USN: Entitlement to disability separation pay with a 20 percent disability rating (increased from 10 percent) effective date of discharge.   
     
3.  Please ensure all necessary actions are taken to implement these decisions including notification to the former members once those actions are complete.

	XXXXXXXXXXXXXXXXXX
	Acting,