RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2015-02322
BRANCH OF SERVICE:  Marine Corps 	SEPARATION DATE:  20050215

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E5, Warehouse Clerk, medically separated for “left knee anterior pain,” with a disability rating of 10%.  

CI CONTENTION:  The CI’s knee conditions have worsened.  The 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 - 20041123	VARD - 20050824	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Left Knee Anterior Pain	5299-5003	10%	Left Knee Condition	5099-5020	NSC	20050301	
Left Knee Post Traumatic Patella Alta	Cat II	Right Knee Patellar Tendon Rupture	5299-5259	10%		
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  20%	

ANALYSIS SUMMARY:  

Left Knee Pain.  According to the service treatment record (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s “left knee anterior pain” condition began in September 1998 as part of a complaint of bilateral knee pain after performing physical exercise.  His diagnosis at that time was bilateral retro-patellar pain syndrome (RPPS).  The next clinical encounter was dated December 2003 which indicated the CI had a surgical repair of a ruptured right sided patellar tendon pursuant to a basketball related injury.  Despite aggressive physical therapy (PT) and rehabilitation, the CI’s overall condition did not improve sufficiently to allow unrestricted duty.  

During the October 2004 MEB examination 4 months prior to separation, the record indicated that the CI reported left knee pain and left-sided quadriceps weakness.  He maintained the ability to perform most of his activities of daily living, but endorsed difficulty in maneuvering stairs or running.  His physical examination (PE) was documented as the “left knee” (non-surgical knee) with a range of motion (ROM) of 10 degrees of extension (0 normal), described as “extensor lag” and flexion to 125 degrees (140 normal).  Additionally, the PE documented patella alta, atrophy of the quadriceps muscle, and crepitus of the left knee and leg.  Radiographs of both knees identified patella alta on the right (consistent with surgery) and enthesopathic change about the left patella.  

At the VA Compensation and Pension (C&P) evaluation on 1 March 2005, 2 weeks after separation, the CI reported the inability to run or stand for an extended period of time.  The PE documented a high-riding right sided kneecap, mild right sided crepitus, and 130 degrees flexion.  There was no clinical evidence of joint instability and his gait remained normal.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB listed and rated the “left knee anterior pain condition” at 10%, coded 5299-5003 (analogous to degenerative arthritis).  The VA determined the “left knee anterior pain” condition was not service-connected and the right knee condition was rated at 10%, coded 5299-5259 (analogous to semilunar cartilage, removal of). 

Panel members first extensively discussed the PEB’s anatomical identification of the CI’s unfitting condition.  Based upon the objective X-ray finding of patella alta coupled with the entirety of the STR after 1998 referring strictly to the right knee, panel members concluded that the PEB erroneously identified the “traumatic patella alta” (side of surgery) condition as the left knee when it should have been identified as the primary unfitting right knee condition.  

Additionally, panel members agreed that based upon further X-ray evidence near the time of separation, the PEB’s identification of arthritis in the left knee was indeed correct; however, that condition, in and of itself, did not render the CI unfit in performing his military duty and thus was erroneously listed as the primary unfitting condition.

The panel then considered the impairment rating for the (correctly identified) unfitting right knee condition and concluded that after correcting the erroneous anatomic identified site of concern, the VA examination held the greatest probative value given its near proximity to separation.  After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the panel concluded that despite the presence of mild crepitus, a high-riding patella, and near normal ROM of the right knee, there was no additional VASRD code that would support a disability rating above a 10% rating.

Contended PEB Condition:  Left Knee Post Traumatic Patella Alta.  The panel’s main charge is to assess the fairness of the PEB’s determination that the contended Navy Category II condition was not unfitting.  As previously described above, the panel agreed that the PEB erroneously identified the anatomical site of the original injury as left vs right and that the single degenerative arthritis finding in the left knee did not significantly interfere with satisfactory duty performance near the time of separation.  Additionally, all panel members further agreed that the radiographic findings within the left knee would not support a Category II classification for its arthritic development and was not a contributing factor to the primary traumatic right knee condition.  After due deliberation, the panel concluded that the preponderance of evidence with regard to any functional impairment of the listed unfitting “left knee, anterior knee pain due to early patellofemoral arthritis” would not support a positive rating IAW VASRD §4.71a. 

BOARD FINDINGS:  In the matter of the PEB’s listed CAT II condition of “left knee post traumatic patella alta” and IAW VASRD §4.71a, the panel unanimously recommends a descriptive change to reflect “right knee post traumatic patella alta” and an additional change to reflect it as the primary unfitting condition under VASRD code 5003 at 10%.  In the matter of the PEB’s listed unfitting condition of “left knee, anterior knee pain due to early patellofemoral arthritis” and IAW VASRD §4.71a, the panel unanimously recommends that it did not support any positive degree of impairment.  There are no other conditions within the panel’s scope of review for consideration.  Panels usually do not recommend a change in the PEB’s coding options if not resulting in a change in the overall disability rating.  However; this panel unanimously agreed that due to the apparent errors of documentation, it was best to provide further clarification and proper documentation and thus modify the coding parameters.  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	
Left Knee Anterior Pain	5003 	0%	
Right Knee Post Traumatic Patella Alta	5003	10%	
COMBINED	10%	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20150901, 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:  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, USMC
		- XXXXXXXXXXXXXXXXXX, former USMC
	 	- XXXXXXXXXXXXXXXXXX, former USMC
		- XXXXXXXXXXXXXXXXXX, former USMC
		- XXXXXXXXXXXXXXXXXX, former USMC

		
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