RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2015-02180
BRANCH OF SERVICE:  Marine Corps 	SEPARATION DATE:  20070430

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E4, Assaultman, medically separated for “degenerative arthritis, chondromalacia patella, and osteochondral defect left knee,” and three other category II conditions that contributed to the unfitting condition, with a disability rating of 10%.  

CI CONTENTION:  Contended bilateral knee and sleep apnea.  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 - 20070221	VARD - 20070822	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Degenerative Arthritis…Left Knee	5009-5003	10%	Osteoarthritis, Left Knee	5003	10%	20070621	
Status Post Resection…	Cat II					
Chondromalacia Patella…						
Chondromalacia Medial Femoral Condyle…						
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  80%	

ANALYSIS SUMMARY:  

Left Knee.  According to the service treatment record (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI underwent left knee arthroscopy in April 2006 for Grade II chondromalacia patella.  Following surgery further treatment did not result in improvement sufficient to allow unrestricted duty.  Radiographic studies showed degenerative changes of the left knee, edema and a possible fracture in the patella.  
The 8 September 2006 MEB NARSUM examination, 7 months prior to separation, noted complaints of pain with activity.  The DD Form 2808 was referenced under examination.  During the October 2006 MEB examination (recorded on DD Forms 2807-1 and 2808), 6 months prior to separation, the CI reported increased knee pain with activity, stair climbing, and prolonged sitting and standing.  The physical examination showed flexion of 90 degrees (normal 140) and extension of 0 degrees (normal 0).  

The 7 December 2006 NARSUM addendum, 4 months prior to separation, showed full range of motion (ROM) and a positive grind and patellar compression.  There was no laxity or instability.  The CI had pain on McMurray’s testing (for meniscal signs) and some tenderness along the patellar tendon.  The April 2006 diagnostic knee arthroscopy showed scar tissue with no evidence of chondromalacia or meniscal tear.  

At the 13 February 2007 consult (second opinion for MEB/PEB), the CI’s physical examination showed full ROM with discomfort on lateral rotation.  There was crepitus and tenderness without redness or swelling.  

At the 21 June 2007 VA Compensation and Pension (C&P) evaluation, 2 months after separation, the CI reported sharp pain in left knee.  The physical examination showed a normal gait with -5 degrees of extension and 130/140 degrees of flexion.  There was some swelling without specific effusion.  There was no laxity or instability and McMurray’s test (for meniscal symptoms) was negative.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the left knee condition 10%, analogously coded 5099-5003 (degenerative arthritis).  The Navy PEB’s Category II diagnoses of “status post resection…knee pain,” “chondromalacia patella Grade II,” and “chondromalacia medial femoral condyle…” are intrinsic to the rated condition and a separate rating cannot be supported without pyramiding (VASRD §4.14); thus, they are appropriately subsumed in the same rating.  The VA rated the left knee condition 10%, coded 5003 (degenerative arthritis), based on the C&P examination 2 months after separation, citing full ROM and pain with motion.  

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), and there was no history of dislocated meniscus or loose body causing frequent locking with recurrent effusions (5258).  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 left knee condition.  

BOARD FINDINGS:  In the matter of the left knee condition and IAW VASRD §4.71a, the panel unanimously recommends no change in the PEB adjudication.  There were 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 20150810, 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

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

		
	
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	     				  Acting