RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2016-00526
BRANCH OF SERVICE:  Navy	SEPARATION DATE:  20090415

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E6, Instructor and SSBN Weapons Equipment Technician, medically separated for “right knee patellar chondromalacia” with a disability rating of 10%.

CI CONTENTION:  He requests a retirement for the knee condition which ended his career.  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 Medical Evaluation Board (MEB), but determined by the PEB 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.  The panel’s authority is limited to assessing the fairness and accuracy of PEB rating determinations and recommending corrections when appropriate.  The panel’s assessment of the PEB rating determination is based on review of medical records and all available evidence relevant to application of the Veterans Affairs Schedule for Rating Disabilities (VASRD) standards for 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, which operates 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 disability at the time of separation.  

RATING COMPARISON:

SERVICE PEB - 20090115	VARD - 20090605	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Right Knee Patellar Chondromalacia	5099-5003	10%	Right Knee ACL Tear…	5260	10%	20090305	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  70%	

ANALYSIS SUMMARY:  

Right Knee Patellar Chondromalacia.  According to the service treatment record (STR) and MEB narrative summary (NARSUM), the CI’s right knee condition began in 2005 when he developed pain while maneuvering stairs.  Right knee arthroscopic surgery was performed on 21 February 2008, 14 months prior to separation, which revealed kneecap chondromalacia and surrounding synovitis and required local debridement. 

The 14 August 2008 MEB NARSUM examination, 8 months prior to separation, noted complaints of right knee pain.  Physical examination (PE) revealed non-tender and well-healed surgical portal scars.  Range of motion (ROM) of the right knee demonstrated normal extension and decreased flexion of 125 degrees (normal 140).  Crepitus of the right kneecap was present without joint effusion.  Painful motion was present. 

During a physical therapy encounter on 18 December 2008, 4 months prior to separation, the CI’s PE was essentially unchanged noting only an additional 5 degrees of limited flexion (120 instead of 125 degrees at earlier examination).  Painful motion was not addressed. 

At the 5 March 2009 VA Compensation and Pension (C&P) examination, one month prior to separation, the CI reported a right knee “wear and tear injury.”  The PE revealed a normal and brisk gait.  Bilateral knee ROM noted normal extension and decreased flexion of 125 degrees.  Provocative testing for instability remained stable and tight.  Painful motion was not addressed. 

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the right knee condition 10%, analogously coded 5099-5003 (arthritis, degenerative).  The VA also rated the right knee condition 10%, coded 5260 (leg, limitation of flexion), based on the C&P examination, citing painful motion.

The panel agreed 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 reported on the NARSUM pre-separation examination.  There was no STR history or evidence, proximate to separation, of dislocated meniscus or loose body causing frequent locking with recurrent effusions (5258), to support a rating under that code.  There was no fracture, nonunion or malunion of the femur or tibia to support consideration under the respective codes for knee impairment related to long bone conditions (5255, 5262).  Therefore, there was no higher rating than the 10% adjudicated by the PEB under any applicable code.  After due deliberation, considering all the evidence and mindful of VASRD §4.3 (reasonable doubt), the panel concluded there was insufficient cause to recommend a change in the PEB adjudication for the right knee condition.

BOARD FINDINGS:  In the matter of the right knee condition and IAW VASRD §4.71a, the panel 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 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 20160824, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs 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 USN
		- XXXXXXXXXXXXXXXXXX, former USMC
		- 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 USN
		- XXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXX, former USMC
		- XXXXXXXXXXXXXXXXXX, former USMC