RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2015-02066
BRANCH OF SERVICE:  Navy 	SEPARATION DATE:  20091031

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E3, Information Systems Technician, medically separated for patella chondromalacia 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 - 20090806	VARD - 20100513	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Patella Chondromalacia (Right)	5099-5003	10%	Patella Chondromalacia, Right	5099-5014	NSC	STR	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  NA	

ANALYSIS SUMMARY:  

Right Knee.  According to the service treatment record (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI injured her right knee while running in November 2008 (12 months before separation).  Imaging (MRI) did not demonstrate any significant pathology (ligaments and menisci intact, no surgical indications).   Early STR clinical entries documented grossly normal range of motion (ROM), but there was conflicting evidence in later entries as elaborated below.  There was one entry that denied subjective locking and a conflicting one that noted a complaint of locking and buckling.  There was STR confirmation of objective joint stability without persistent effusion, mechanical impingement, or other VASRD-ratable findings.

The 12 March 2009 NARSUM examination, 8 months prior to separation, documented non-specific pain (no comment regarding subjective instability or locking) that was exacerbated by walking and prohibited physical training.  The physical examination recorded a “mild antalgic gait,” the absence of effusion, stability to stress testing, and negative signs of impingement.  With regards to ROM, the NARSUM orthopedist recorded “the patient self-limits to about 20 degrees of flexion [140 normal] because further flexion gives her pain.”  Extension was not mentioned.  

There was an STR clinical entry by the NARSUM orthopedist on 19 June 2009 (3 months after the NARSUM) that documented flexion to 45 degrees (no extension recorded), clarifying that this was voluntarily limited by the CI due to pain (passive ROM was normal).  The examination noted the absence of effusion or instability without mention of gait disturbance.  

The CI failed to report for a scheduled VA examination and there was no probative post-separation evidence in this case.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB’s 10% rating under code 5099-5003 (analogous to degenerative arthritis) did not cite a rationale.  The VA denied service connection citing the failure to report for a VA examination to “establish any link between your current disability and your military service.”  There was no evidence for persistent effusion and locking, instability, or fracture with nonunion or malunion to support a rating higher than 10% under any applicable code; but, the panel deliberated whether a higher rating could be supported by the above ROM evidence.

Code 5260 (limitation of flexion) offers a 10% rating for flexion limited to 45 degrees and 20% (maximum available) for limitation to 30 degrees.  Members agreed, however, that the NARSUM flexion to 20 degrees was superseded by the same examiner’s measurement of 45 degrees which was more temporally probative to separation.  The latter met only the 10% threshold of code 5260.  Furthermore it was evident that the CI’s subjective pain threshold disproportionately affected the measurements; and, members agreed that a refusal to attempt joint excursion beyond the onset of pain compromises the probative value of a ratable measurement.  

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 of 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 20160615, 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

      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 USN
		- XXXXXXXXXXXXXXXXXX, former USMC
		- XXXXXXXXXXXXXXXXXX, former USMC
		-XXXXXXXXXXXXXXXXXX, former USN
		-XXXXXXXXXXXXXXXXXX, former USMC

		
		
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	     				  Acting