RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2016-01099
BRANCH OF SERVICE:  nAVY 	SEPARATION DATE:  20040815

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E4, Electronics Technician, medically separated for “left knee PFPS [patellofemoral pain syndrome]” with a disability rating of 10%.  

CI CONTENTION:  The condition continues to worsen.  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 it reasonably reflects the severity of the disability at the time of separation.  

RATING COMPARISON:  

SERVICE PEB - 20040709	VARD - NA	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Left Knee PFPS	5099-5003	10%	No VA Examination Proximate to Separation in Evidence 	
Left Knee Plica Syndrome	Cat II		
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  NA	

ANALYSIS SUMMARY:  

Left Knee PFPS.  According to the service treatment record and Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI underwent arthroscopic left knee surgery in March 2004 for a medial meniscus tear and medial plica syndrome.  The medial and lateral menisci were normal but there was evidence of a medial parapatellar plica, which was resected.  

At the time of his 14 May 2004 orthopedic clinic examination, 2 months after surgery and 3 months before separation, the CI reported continued left knee pain, although it was improved from before the surgery.  He was unable to climb stairs secondary to his pain, which was also exacerbated by prolonged standing and running.  Physical examination showed a well-healed surgical incision with no evidence of effusion or erythema.  His left knee range of motion (ROM) was flexion of 130 degrees (normal 140) and extension of 0 degrees (normal), with “tenderness” noted with extreme flexion.  There were no signs of instability.  The examiner referenced a May 2004 X-ray (not in evidence) that showed mild degenerative joint disease of the left knee.  

During the 7 June 2004 MEB examination (recorded on DD Forms 2807-1 and 2808), 2 months prior to separation, the CI reported left knee giving out 3-5 times per day and locking during and after running.  The 8 June 2004 MEB NARSUM examination showed an unremarkable gait.  There was minimal swelling of the lateral aspect of the knee, with no tenderness or signs of ligamentous laxity.  The examiner recorded full ROM without crepitus, patellar grind or signs of meniscal injury.  Painful motion was not addressed.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the left knee condition 10%, coded 5099-5003 (analogous to degenerative arthritis).  The PEB also listed left knee plica syndrome as a related Category II condition (a condition that contributed to the primary unfitting condition but was not separately ratable).  The impairment from the left knee plica syndrome was properly subsumed under the overall rating for the left knee PFPS IAW §4.14 (avoidance of pyramiding; more than one rating based on the same impairment is prohibited).  The VA rated the left knee condition 0%, coded 5299-5260 (analogous to limitation of motion of the leg), based on the C&P examination 17 months after separation, citing objective findings that were minimal in nature and therefore did not warrant a compensable evaluation.  

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).  There was no history or evidence of dislocated meniscus or loose body causing frequent locking with recurrent effusions (5258), or history of surgery to remove a meniscus (5259) to support a rating under those codes.  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 possible VASRD §4.71a rating higher than the 10% adjudicated by the PEB under any applicable code.  After due deliberation, considering all of 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 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.  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 20160913, 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, former USN
		- XXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXX, former USMC
		- XXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXX, former USMC
		- XXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXX, former USMC
		- XXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXX, former USMC
		- XXXXXXXXXXXXXXXXXX, former USMC
		- XXXXXXXXXXXXXXXXXX, former USMC
		- XXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXX, former USN

		
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	     				                                      Acting