RECORD OF PROCEEDINGS PHYSICAL DISABILITY BOARD OF REVIEW
NAME:  XXXXXXXXXXXXXXXXX	CASE: PD-2017-02772
BRANCH OF SERVICE: NAVY	SEPARATION DATE: 20060904

SUMMARY OF CASE: Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E5, Seabee Equipment Operator, medically separated for “right patellofemoral instability” with a disability rating of 10%.

CI CONTENTION: Review was requested of both knees and an additional condition not identified by the Medical Evaluation Board (MEB) and/or Physical Evaluation Board (PEB). 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 PEB to be unfitting for continued military service, and when specifically requested by the CI, those conditions identified by the 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 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 - 20060526	VARD – 20070726 & 20071003	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Right Patellofemoral Instability	5299-
5003	10%	Patellar Femoral Syndrome,
Right Knee	5299-5260	10%	20070324	
Bilateral Patellofemoral Syndrome	Cat II	Patellar Femoral Syndrome, Left Knee	5299-5260	0%	20070324	
COMBINED RATING: 10%	COMBINED RATING OF ALL VA CONDITIONS: 20%	

ANALYSIS SUMMARY:

Right Patellofemoral Instability. According to the service treatment record (STR) and MEB narrative summary (NARSUM), the CI underwent initial right knee arthroscopic surgery in December 2004. He underwent a second surgery for lateral patella retinacular release and open right medial patella ligament reconstruction in January 2005, and a third surgery in October 2005 for chronic right patella lateral subluxation and subluxation iliotibial band fibrosis. X-rays documented surgical changes and retained hardware. The 18 April 2006 MEB NARSUM examination, 5 months prior to separation, noted complaints of chronic right anterior knee pain, but he didn’t have patellofemoral subluxation as a result of the surgeries. Physical examination showed the right knee was well-aligned and there was no patellofemoral frank instability. There were multiple surgical scars. The right knee had full range of motion (ROM), with painful motion and patellofemoral grind. During the MEB examination (recorded on DD Forms 2807-1 and

2808), 10 days later, the CI reported right knee pain and swelling. Physical examination revealed “full” ROM of the right knee with no instability and no swelling.

At the 24 March 2007 VA Compensation and Pension (C&P) examination, 7 months after separation, the CI reported right knee pain that got worse with walking or standing for long periods or when climbing stairs. The CI indicated the pain and locking was a lot better since he had surgery. Physical examination revealed three scars over the right knee. Joint shape and patella appeared normal and there was no deformity. Right knee ROM showed flexion of 130 degrees (normal 140) and extension of 0 degrees (normal) after repetition. Mild crepitus was present. There was no instability or joint tenderness and McMurray’s test (meniscal) was negative. X-rays of the right knee on 26 March 2007 revealed post-surgical changes at the proximal right tibia with possibly healing fracture and residual linear lucency/incomplete bony union seen. No hardware failure or loosening was identified. Joint spaces were preserved and no other significant osseous abnormalities were noted. Right knee MRI in September 2007, 12 months after separation, revealed post-surgical changes and a small meniscal tear of the posterior horn and body of the lateral meniscus extending through the inferior articular surface.

The panel directed attention to its rating recommendation based on the above evidence. The PEB rated the right knee condition 10%, analogously coded 5003 (degenerative arthritis). The PEB also listed bilateral patellofemoral syndrome as a related Category II condition that contributed to the primary unfitting condition but was not separately ratable. The impairment from the right patellofemoral syndrome was properly subsumed under the rating for the right patellofemoral instability IAW §4.14 (avoidance of pyramiding; more than one rating based on the same impairment is prohibited); however the left patellofemoral syndrome was not clearly subsumed and will be addressed separately. The VA also rated the right knee condition 10%, analogously coded 5260 (leg, limitation of flexion), based on the C&P examination, citing painful and slightly limited motion. The left knee was rated 0%, analogously coded 5260, citing full ROM with a normal examination.

Regarding the right knee condition, 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).

The panel next deliberated if the left knee was separately unfitting and ratable. The left knee was not noted on limited duty forms, or implicated in the non-medical assessment, and it was unclear which knee(s) was forwarded on the NAVMED 6100/1. However, the left knee was implicated on the NARSUM and PEB. The panel considered that regardless of a separate fitness determination, the left knee would rate no higher than the combined 10% adjudicated by the PEB for the Category I and II conditions combined. There was therefore no VASRD §4.71a rating higher 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 patellofemoral instability (with Category II bilateral patellofemoral syndrome) 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.

DEPARTMENT OF THE NAVY
SECRETARY OF TIIE NAVY COUNCIL OF REVIEW BOARDS 720 KENNON STREET SE STE 309
WASHINGTON NAVY YARD, DC 20374-5023

IN REPLY REFER TO:
1850
CORB: 003
10 Sep 20

From: Director, Secretary of the Navy Council of Review Boards To:	XXXXXXXXXXXXX

Subj: PHYSICAL DISABILITY BOARD OF REVIEW (PDBR) Ref:	(a) DoDI 6040.44
1.	Pursuant to reference (a), the PDBR reviewed your case and forwarded its recommendation to the Department of the Navy on 13 Aug 2020 for appropriate action.

2.	On 27 August 2020, the Assistant Secretary of the Navy (Manpower & Reserve Affairs) accepted the recommendation of the PDBR ofno 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.