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IN REPLY REFER TO

12 Feb 20

From: To:

Director, Secretary of the Navy Council of Review Boards 
PD-2017-02063

Subj: Ref:

PHYSICAL DISABILITY BOARD OF REVIEW (PDBR)

(a) DoDI 6040.44
(b)	PDBR ltr dtd 7 Feb 19

1.	Pursuant to reference (a), the PDBR reviewed your case and forwarded its recommendation (reference (b)) to the Department of the Navy of 15 October 2019 for appropriate action.

I
2.	On 31 January 2020, the Assistant Secretary of the Navy (Manpower & Reserve Affairs) accepted the recommendation of the PDBR of no change to your characterization of separation or disability rating assigned by the Department of the Navy's Physical Evaluation Board.

3.	The Secretary's decision on your PDBR application is final and is not subject to appeal or additional review by the Board for Correction of Naval Records.

RECORD OF PROCEEDINGS PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXX		CASE: PD-2017-02063 BRANCH OF SERVICE:  NAVY	SEPARATION DATE: 20080115

SUMMARY OF CASE: Data extracted from the available evidence of record reflects this covered individual (CI) was a Reserve E5, Independent Duty Ashore Storekeeper, medically separated for “dislocation of the right patella” with a disability rating of 20%.

CI CONTENTION: No specific was contention made.  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 - 20071004	VARD -20080717	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Dislocation of the Right Patella	5299-5262	20%	Residuals of Right Patellar Fractures	
5299-5260	
10%	
20080409	
Patellofemoral Dysfunction	Cat II					
Fracture of the Patella	Cat II					
COMBINED RATING: 20%	COMBINED RATING OF ALL VA CONDITIONS: 60%	
	
ANALYSIS SUMMARY:

Dislocation of the Right Patella. According to the service treatment record and MEB narrative summary (NARSUM), the CI underwent a right knee arthroscopy in June 2004, which was notable for loose bodies that were removed and Grade II patellar chondromalacia. After a second injury in March 2007, an arthroscopy showed a medial patella avulsion fracture with loose articular cartilage, which was removed, and a lateral release was performed. An MRI on 25 June 2007 showed significant cartilaginous thinning involving the lateral patellar facet, a presumed 1-cm ganglion cyst posterior to the medial meniscus, an intact, mildly discoid lateral meniscus and   a

joint effusion. Despite physical therapy, the CI continued to report pain rated at 5/10 and an effusion, which caused difficulty in performing daily activities.

The 25 July 2007 MEB NARSUM examination, 6 months prior to separation, noted complaints of ongoing knee pain. Physical examination showed a mild-to-moderate effusion within the right knee joint capsule with tenderness to the patellar borders and patellofemoral joint. Range of motion (ROM) was 0-100 (normal 0-140). No instability or laxity was noted with Lachman’s, drawer, and varus/valgus testing, and a pivot shift test was negative. Guarding was present with McMurray testing (to determine a meniscal tear). A slight limp was noted, and he was unable to perform a squatting maneuver or duck walk due to pain.  Strength and sensation were normal.

At the 9 April 2008 VA Compensation and Pension (C&P) examination, 3 months after separation, the CI reported constant anterior patellar pain, and stiffness with sitting and standing for long periods. Physical examination showed that he favored his right leg, but did not use a cane. Drawer, Lachman’s and McMurray’s tests were negative, with the knee stable to varus and valgus stress testing. There was no crepitus or pain with patellar compression, and no tenderness, erythema or generalized edema. A small pocket of edema was present at both sides of the patella without tenderness, and ROM was 0-130 degrees with some discomfort, but without additional limitation with repetition.

The panel directed attention to its rating recommendation based on the above evidence. The PEB rated the dislocation of the right patella 20%, coded 5299-5262 (analogous to tibia and fibula, impairment). Members agreed that the patellofemoral dysfunction and fracture of the patella, determined to be Category II conditions (contribute to the primary unfitting condition but were not separately ratable), represented an intertwined diagnoses, and that the overall knee impairment from all listed diagnoses was subsumed under the ratings for the knee by both the PEB and the VA; more than one rating based on the same impairment is prohibited, IAW §4.14 (avoidance of pyramiding). The VA rated the residuals of right patellar fracture 10%, coded 5299- 5260, based on the C&P examination, citing pain on motion and edema. Members noted there was no limitation of flexion or extension which supported ratings under diagnostic codes 5260 or 5261. However, there was evidence of a moderate knee disability to support the 20% rating assigned by the PEB, although there was no documentation or report of a malunion of either the tibia or fibula. Neither was there malunion of the femur, if code 5255 (femur impairment) were a consideration to rate the knee condition. There was no evidence of marked knee disability to support a 30% rating under code 5262, no history of dislocated meniscus or loose body causing frequent locking with recurrent effusions (5258), and no evidence of ligamentous instability or laxity for a rating under code 5257 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 dislocation of the right patella condition.

BOARD FINDINGS: In the matter of the dislocation of the right patella condition and IAW VASRD
§4.71, 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 20170309, w/atchs Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Record