RECORD OF PROCEEDINGS PHYSICAL DISABILITY BOARD OF REVIEW
NAME:  XXXXXXXXXXXXXXXXXXXXXXX	CASE: PD-2017-05279
BRANCH OF SERVICE: NAVY	SEPARATION DATE: 20090901

SUMMARY OF CASE: Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty 02, Surface Warfare Officer, medically separated for “trochlear osteochondral defect, right knee” with a disability rating of 10%.

CI CONTENTION: “Review all conditions.” 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 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 - 20090708	VARD – 20090903	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Trochlear Osteochondral Defect, Right Knee	5257	10%	
Residual Osteochondral Defect of the Medial Femoral Condyle, Right Knee	
5257	
10%	
20091121	
Right Knee Patellofemoral Dysfunction	Cat II					
Right Knee Chondromalacia						
Right Knee Osteochondritis Dissecans						
Residuals of Fracture of the Left Fifth Toe	Cat III	Healed Fracture Left Fifth Toe Proximal Phalangeal Region	5299
-   5284	0%	20091121	
Cervical Dysplasia	Cat III	No VA Placement	
COMBINED RATING: 10%	COMBINED RATING OF ALL VA CONDITIONS: 20%	

ANALYSIS SUMMARY:

Right Knee Trochlear Osteochondral Defect. According to the service treatment record (STR) and MEB narrative summary (NARSUM), the CI’s right knee condition began in January 2007 after doing small boat operations, although she had a history of a right knee medial plica removal prior to enlistment. She suffered a direct blow to the right patella with immediate pain and swelling, and orthopedic evaluation revealed a trochlear cartilaginous defect for which she had a microfracture surgery in February 2007. In January 2008, she underwent an osteochondral autograft transfer system (OATS) procedure and had an uncomplicated postoperative course. However, she continued to have right knee pain despite extensive physical therapy. Right knee X-rays in October 2008 were normal, while a follow-up MRI indicated good incorporation of

cartilage with some residual articular surface chondral irregularity. A CT scan of the knees in November 2008 revealed mild lateral patellar tilt bilaterally, and an MRI in December 2008 showed no acute bony or significant degenerative changes with postsurgical changes not apparent radiographically. A series of three Synvisc injections to treat the chondromalacia was completed in December 2008, which decreased the CI’s pain for several months.

The 3 March 2009 MEB NARSUM examination, 6 months prior to separation, noted complaints of continued right knee pain. Physical examination showed that she walked with an upright posture and a non-antalgic gait and that the surgical sites were well-healed. Range of motion (ROM) tests showed hyperextension to approximately 5 degrees (normal 0) and flexion to 135 degrees. There was slight patellofemoral crepitus with motion and discomfort with a patellar grind test, but a negative patellar apprehension sign. There was no significant patellar maltracking noted with full knee ROM, to include a negative J sign. The knee was stable to varus and valgus testing for laxity, and there was no instability or effusion.

At the 10 April 2009 VA Compensation and Pension (C&P) examination, 5 months before separation, the CI reported residuals of persistent right knee pain after the microfracture and OATS procedures. Physical examination showed a mildly antalgic gait on the right, and ROM was from 0-135 degrees with crepitation and end point pain. There was no instability, laxity, or evidence of a meniscal tear.

The panel directed attention to its rating recommendation based on the above evidence. The PEB rated the right knee condition 10%, analogously coded 5257 (knee, other impairment of), and listed right knee patellofemoral dysfunction, chondromalacia, and osteochondritis dissecans as Category II conditions (contribute to the primary condition but not separately ratable). Panel members agreed that these related diagnoses could not be reasonably justified as separately unfitting; nor would separate ratings be achievable without violation of VASRD §4.14 (avoidance of pyramiding). The VA also rated the right knee condition 10%, analogously coded 5257, based on the C&P examination, citing slight, recurrent subluxation or lateral instability, with a higher 20% rating not warranted due the absence of moderate subluxation or lateral instability. The panel noted that analogous code 5299-5259 (cartilage, semilunar, removal of, symptomatic) was applicable in this case since debridement of the medial femoral condyle was performed at the time of the OATS procedure; however, but the maximum 10% rating under that code provided no additional benefit to the CI. Panel members considered other VASRD knee and analogous codes, but all were less applicable and/or not advantageous for rating. There was therefore no higher rating than the 10% adjudicated by the PEB. 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.

Contended PEB Conditions: Residuals of Fracture of the Left Fifth Toe and Cervical Dysplasia. The panel’s main charge is to assess the fairness of the PEB determination that the contended conditions were not unfitting. There was only one limited duty form found in the STR, which implicated the right knee condition, but neither of the contended conditions, which also note mentioned in the non-medical assessment. Thus, there was no performance-based evidence from the record that either of the conditions significantly interfered with satisfactory duty performance at separation. After due deliberation, the panel concluded there was insufficient cause to recommend a change in the PEB fitness determination for either of the contended conditions, so no additional disability ratings are recommended.

BOARD FINDINGS: In the matter of the right knee condition and IAW VASRD §4.71a, the panel recommends no change in the PEB adjudication. In the matter of the contended residuals of fracture of the left fifth toe and cervical dysplasia, the panel recommends no change from the

PEB determinations as not unfitting. 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:

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

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

Subj: PHYSICAL DISABILITY BOARD OF REVIEW (PDBR) Ref:	(a) DoDI 6040.44

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

I.	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.