RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2016-01430
BRANCH OF SERVICE:  marine corps 	SEPARATION DATE:  20040430

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E5, Machine Gunner, medically separated for “left patellar chondromalacia” 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 - 20040120	VARD - 20050415	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Left Patellar Chondromalacia	5299-5003	10%	Recurrent Dislocation of the Left Patella with Patellar Instability, Status Post Patellar Chondroplasty	5299-5259	10%	20040825	
Left Knee Patellar Instability with History of Dislocations (x3)	Cat II					
S/P Patellar Chondroplasty	Cat II					
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  30%	

ANALYSIS SUMMARY:  

Left Patellar Chondromalacia.  According to the service treatment record (STR) and Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI had a lengthy history of left knee problems dating at least back to his 1993 enlistment, becoming more severe starting in 1998 and including three patellar dislocations.  He underwent left knee diagnostic arthroscopy and patellar chondroplasty in March 2002, which confirmed patellofemoral chondromalacia and ruled out meniscus tears or loose bodies.  After recovery from the surgery, he was able to return to full duty and was pain-free until September 2003, when he twisted his knee running and again dislocated his patella.  Due to his two 6-month periods of limited duty (LIMDU) and his longstanding knee issues, he was referred to an MEB.  

The 23 October 2003 MEB NARSUM examination, 6 months prior to separation, showed left knee effusion and tenderness.  Left knee range of motion (ROM) revealed flexion to 120 degrees (normal 140) and extension to 0 degrees (normal), with painful motion.  Patellar grind was positive with crepitus during patellar compression.  The examiner described “an impressive patellar apprehension sign.”  At the 25 August 2004 VA Compensation and Pension (C&P) evaluation, 4 months after separation, physical examination showed left knee flexion to 65 degrees and extension to 0 degrees, with mild tenderness and a normal gait. 

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the left knee condition 10%, analogously coded 5299-5003 (degenerative arthritis).  The PEB also listed “left knee patellar instability with history of dislocations times three, and s/p patellar chondroplasty” as related Category II conditions (contribute to primary unfitting condition but were not separately ratable).  The impairment from these conditions were properly subsumed under the overall rating for the left patellar chondromalacia IAW §4.14 (avoidance of pyramiding; more than one rating based on the same impairment is prohibited).  The VA also rated the left knee condition 10%, analogously coded 5299-5259 (symptomatic removal of semilunar cartilage), based on the C&P examination 4 months after separation, citing symptoms of decreased motion due to chondroplasty.  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).  The 5259 code was not applicable in this case and 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).  There was therefore no VASRD §4.71a route to a 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 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 20161013, 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