RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXX	CASE:  PD-2016-00346
BRANCH OF SERVICE:  Navy 	SEPARATION DATE:  20060823

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E3, Ship’s Serviceman, medically separated for “unresolved patella-femoral pain/chondromalacia patellae, s/p lateral release and meniscal debridement left knee” 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 - 20060719	VARD - 20131017	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Unresolved Patello-femoral Pain/Chondromalacia Patellae, S/P Lateral Release and Meniscal Debridement Left Knee	5299-5003	10%	Residuals of S/P Left Knee ACL and Meniscus Tear Repair	5257	0% 	STR 	
Persistent Knee Pain	Cat II 					
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  0%	

ANALYSIS SUMMARY:  

Left Knee Patellofemoral Pain Condition.  According to the service treatment record (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s left knee condition began in March 2005 after running.  The CI underwent a left anterior cruciate ligament (ACL) reconstruction with meniscal debridement in June 2004.  A magnetic resonance imaging study (MRI) of the left knee performed on 14 May 2005 showed small fragments of the meniscus located adjacent to the PCL (posterior cruciate ligament), a focal area of partial thickness cartilage loss in the posterior lateral condyle overlying the anterior horn of the lateral meniscus at the site of one of the prior contusions and an ACL graft that was intact.  The CI underwent an arthroscopic meniscal debridement in December 2005.  

At the 7 April 2006 orthopedic evaluation, 5 months prior to separation, the CI reported persistent left knee pain and locking.  The physical examination showed that the left knee was tender to palpation.  Range of motion (ROM) testing was 0 to 120 degrees (normal 0-140) with 4/5 strength in extension and flexion.  Testing for illiotibial band tightness was positive.  The 17 May 2006 MEB NARSUM examination, 3 months prior to separation, noted complaints persistent left knee pain with intermittent swelling.  The CI described the left knee pain as mild to moderate in intensity, which worsened to moderate to severe intensity with weight-bearing activities.  The examiner referenced the above mentioned 7 April 2006 orthopedic evaluation.  The 22 May 2006 MEB examination (recorded on DD Form 2808), 3 months prior to separation, showed decreased left quad strength and no joint effusion.  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 left knee patellofemoral pain condition 10%, coded 5299-5003 (degenerative arthritis).  The PEB Category II condition, persistent left knee pain, was subsumed in the unfitting left knee patellofemoral pain condition.  The panel first considered whether the Category II condition, “persistent left knee pain,” was appropriately subsumed into the unfitting left knee patellofemoral condition.  As the CI’s file did not lend evidence to any documentation that the persistent knee pain occurred separately or prior to the evidenced left knee patellofemoral pain, the panel concluded that this condition was appropriately subsumed.  

The limitation of motion did not support a rating under the diagnostic codes for limitation of flexion or extension (5260, 5261).  There was a history of meniscal debridement and reports of knee locking, however there was no history of frequent episodes of effusion into the joint for a rating under 5258.   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 are no other conditions within the panel’s scope of review for consideration.  The panel, therefore, recommends 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 20160705, 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:

		- XXXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXXX, former USMC
		- XXXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXXX, former USMC
		- XXXXXXXXXXXXXXXXXXX, former USMC
		- XXXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXXX, former USMC
		- XXXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXXX, former USMC
		- XXXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXXX, former USN