RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXX	CASE:  PD-2017-00277
BRANCH OF SERVICE:  Navy 	SEPARATION DATE:  20051207

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E4, Culinary Specialist, medically separated for “right patellar dislocation” with a disability rating of 10%.  

CI CONTENTION:  He should have received a higher rating for his right knee, which continues to negatively impact his daily activities. 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 - 20050831	VARD - 20060227	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Right Patellar Dislocation	5299-5003	10%	Right Knee Patellar Dislocation	5299-5259	10%	20060201	
Right Knee Extensor Mechanism Malalignment	Cat II					
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  10%	

ANALYSIS SUMMARY:  

Right Patellar Dislocation.  According to the service treatment record and MEB narrative summary (NARSUM), the CI underwent surgery in November 2004 to correct right patellar instability, and despite ongoing physical therapy, he was unable to return to full military duty.  At an orthopedic appointment on 5 April 2005, 6 months after surgery and 8 months prior to separation, the provider reported that the CI was doing well, but still had residual right knee pain aggravated by activities and with some localization in the anterior aspect.  There was “full extension” with minor tenderness, some bogginess, a small effusion, and mild apprehension localized to the knee.  Quadriceps atrophy was noted and an “aggressive” strengthening program was prescribed.

During the 7 July 2005 MEB examination (recorded on DD Forms 2807-1 and 2808), 5 months before separation, the CI reported knee pain that disturbed sleep and required wearing a knee brace.  Physical examination (PE) revealed an area of residual numbness from the surgical scar below the right knee.  Right quadriceps strength was 4/5 and all other lower extremity strength was 5/5.  The 14 July 2005 MEB NARSUM examination, noted complaints of intermittent right knee pain and the inability to run or perform non-impact sports.  The CI denied joint locking or giving way, and the PE revealed no joint instability.  There was atrophy within the right quadriceps muscle and tenderness about the right knee.  Knee range of motion (ROM) was flexion to 135 degrees (normal 140) and extension to 0 degrees (normal); painful motion was not mentioned.   

At the 1 February 2006 VA Compensation and Pension (C&P) examination, 2 months after separation, the CI reported intermittent right knee pain and weakness, but no swelling, heat, redness, stiffness, instability, giving out or locking.  Although not worn at the time of the examination, he admitted to using a knee brace when walking or experiencing pain.  The PE revealed a normal gait and posture and the CI was able to heel-toe walk and squat without pain.  The provider noted a sensory deficit to light touch about the surgical scar, soft tissue swelling, and a small joint effusion.  Right knee ROM was recorded as flexion to 135 degrees and extension to -10 degrees [interpreted as extension limited to 10 degrees].  Maneuvering tests for joint instability were normal, and there was no evidence of crepitus, tenderness, guarding, redness, heat, weakness, abnormal movement, spasms or painful motion; X-rays were normal.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the right patellar dislocation condition 10%, analogously coded 5299-5003 (degenerative arthritis).  The Navy PEB also listed right knee extensor mechanism malalignment as a related Category II condition (contributes to the primary unfitting condition but not separately ratable), and members agreed that this was properly subsumed under the overall rating for the right patellar dislocation IAW §4.14 (avoidance of pyramiding; more than one rating based on the same impairment is prohibited).  The VA also rated the right knee patellar dislocation condition 10%, analogously coded 5299-5259 (cartilage, semilunar, removal of, symptomatic), based on the C&P examination, citing symptomatic removal of the semilunar cartilage.   The panel noted that while there was no limitation of motion which supported a rating under the diagnostic code 5260 for limitation of flexion, but there was limited extension which met criteria for a 10% rating under code 5261, as documented on the VA examination.  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.  Also, 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 higher rating than 10% available under any applicable VASRD 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’s adjudication for the right knee condition.  

BOARD FINDINGS:  In the matter of the right patellar dislocation 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. 

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: