RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2016-00513
BRANCH OF SERVICE:  marine corps	SEPARATION DATE:  20070425

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E5, Unit Level Switchboard Operator/Maintainer, medically separated for “Ehlers-Danlos syndrome” with a disability rating of 10%.

CI CONTENTION:  The VA rated the condition higher.  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 - NA	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Ehlers-Danlos Syndrome (EDS)	5299-5003	10%	No VA Examination Proximate to Separation in Evidence	
Patellofemoral Syndrome	Cat II		
Proximal Fibula Old Healed Fracture or Stress Changes	Cat II		
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  NA	

ANALYSIS SUMMARY:

Ehlers-Danlos Syndrome.  According to the service treatment record and Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI underwent left knee surgery on 26 October 2000 and right knee surgery on 9 October 2001 for chronic bilateral knee pain and instability.  She apparently did well and was able to participate in marathons and triathlons.  On 28 February 2005, the CI was seen in physical therapy and reported a 2-month history of recurrent bilateral knee pain.  She was diagnosed with patellar chondromalacia (degeneration of the cartilage under the kneecap).  She also developed back pain.  She was referred to orthopedics (examination not in evidence), but was referred to a geneticist due to joint laxity and other findings consistent with EDS.  The diagnosis was confirmed.  She was evaluated in cardiology where an echocardiogram demonstrated essentially normal function.  On 25 September 2006, the CI was seen in internal medicine and noted to have a tender left knee.  The range of motion (ROM) was full but painful on the left.  Laxity was not recorded.  

The 2 October 2006 MEB NARSUM examination, 6 months prior to separation, noted complaints of joint laxity and pain of the knees and hips.  The CI also reported some lethargy.  The examination of the back was unremarkable.  There was no swelling or redness.  The ROM was full, but with slight pain.  No comment was made on the hips.  There was no VA examination proximate to separation in evidence.

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the EDS condition 10%, analogously coded 5299-5003 (arthritis, degenerative).  The PEB also listed patellofemoral syndrome and proximal fibula old healed fracture or stress changes as related Category II conditions (conditions that contributed to the primary unfitting condition but were not separately ratable).  The impairment from these two conditions was properly subsumed under the overall rating for the EDS condition IAW §4.14 (avoidance of pyramiding; more than one rating based on the same impairment is prohibited).

The panel also noted that there was no specific VASRD code for EDS.  The only significant manifestation of the disease documented on examination was the bilateral knee pain with motion.  X-rays showed evidence of the prior surgery.  The ROM was full, but painful.  This supported a 10% rating under the code 5003 for X-ray evidence of pathology of 2 or more major joints.  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 EDS condition.

BOARD FINDINGS:  In the matter of the EDS 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.  Therefore, the panel recommends 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 20160714, w/atchs
Exhibit B.  Service 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 USN
		- XXXXXXXXXXXXXXXXXX, former USMC
		- XXXXXXXXXXXXXXXXXX, former USMC
		- XXXXXXXXXXXXXXXXXX, former USMC
		- XXXXXXXXXXXXXXXXXX, former USMC
		- XXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXX, former USMC
		- XXXXXXXXXXXXXXXXXX, former USMC
		- XXXXXXXXXXXXXXXXXX, former USMC
		- XXXXXXXXXXXXXXXXXX, former USMC
		- XXXXXXXXXXXXXXXXXX, former USMC
		- XXXXXXXXXXXXXXXXXX, former USN