RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2015-01903
BRANCH OF SERVICE:  marine corps 	SEPARATION DATE:  20030415

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E3, Military Police, medically separated for “grade III chondromalacia lateral tibial plateau,” with a disability rating of 10%.  

CI CONTENTION:  “Review all conditions.”  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 at the time of separation.  The panel has neither the role nor the authority to compensate for progression or complications of service-connected conditions after separation.  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 - 20030306	VARD - 20100518	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Grade III Chondromalacia Lateral Tibial Plateau	5299-5003	10%	Right Knee ACL Reconstruction and Partial Meniscectomy	5259	10%	20100302	
Status Post Anterior Cruciate Ligament Reconstruction a Second Look Arthroscopy with Lateral Release Right Knee	CAT II					
Grade II Chondromalacia Medial Femoral Condyle and Medial Tibial Plateau						
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  10%	

ANALYSIS SUMMARY:  

Grade III Chondromalacia Lateral Tibial Plateau.  According to the service treatment record (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI underwent a right knee arthroscopically assisted partial excision and repair of a torn lateral meniscus and thermal shrinkage of anterior cruciate ligament (ACL) on 13 November 2001.  The CI was seen in the Emergency Room on 7 January 2002 with increased knee pain since he fell while on leave and reinjured his knee.  He underwent a second surgical procedure on 22 January 2002 for ACL reconstruction of the right knee with a patellar ligament autograft and a revision partial lateral meniscectomy.  The CI continued to have persistent pain and swelling.  On 13 December 2002 he underwent a right knee arthroscopy, which revealed grade II chondromalacia on the medial femoral condyle, a large stump of tissue anterior to the ACL graft, and a portion of the posterolateral tibial plateau articular surface had actually sheared from the underlying subchondral bone.  A lateral release, partial chondroplasty and debridement were performed.  There was also a small focal area of grade III chondromalacia on the lateral femoral condyle.  

At a physical therapy appointment on 29 January 2003, 3 months prior to separation and 7 weeks after his last surgical procedure, the examiner noted a marked effusion on the right peripatellar area with warmth, a floating patella, poor quadriceps tone, and a non-antalgic gait with a range of motion (ROM) of 2-120 degrees (0-140 normal).  The 30 January 2003 MEB NARSUM examination, 3 months prior to separation, noted dramatic improvement in the CI’s anterior knee pain, but he continued to have a moderate effusion.  His ROM was 0-120 degrees without discomfort and his Lachman’s test was intact.  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 grade III chondromalacia lateral tibial plateau condition 10%, analogously coded 5003 (arthritis, degenerative).  The PEB listed status post anterior cruciate ligament reconstruction and second look arthroscopy with lateral release of the right knee and grade II chondromalacia medial femoral condyle and medial tibial plateau conditions as related diagnoses that contributed to the disability in this case.  The panel agreed that these were diagnoses related to the unfitting condition and were not separate conditions that could be separately rated IAW §4.14 (avoidance of pyramiding; more than one rating based on the same impairment is prohibited).

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).  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.  Code 5258 (cartilage, semilunar, dislocated, with frequent episodes of “locking,” pain, and effusion into the joint) was considered; however, it appeared that the dislocated cartilage was removed by the partial chondroplasty, although  the CI still had frequent pain and an effusion, but he had no reported locking.  There was no fracture, nonunion or malunion of the femur or tibia to support consideration under the respective codes for knee impairment related to long bone conditions (5255, 5262).  Therefore, there was 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 panel concluded that there was insufficient cause to recommend a change in the PEB adjudication for the grade III chondromalacia lateral tibial plateau condition.  

BOARD FINDINGS:  In the matter of the grade III chondromalacia lateral tibial plateau 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 20150612, w/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:  PHYSICAL DISABILITY BOARD OF REVIEW (PDBR) RECOMMENDATIONS
 
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 USMC
		- XXXXXXXXXXXXXXXXXX, former USMC
		- XXXXXXXXXXXXXXXXXX, former USMC
		- XXXXXXXXXXXXXXXXXX, former USMC
		- XXXXXXXXXXXXXXXXXX, former USMC
		- XXXXXXXXXXXXXXXXXX, former USMC
		- XXXXXXXXXXXXXXXXXX, former USMC

	
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