RECORD OF PROCEEDINGS PHYSICAL DISABILITY BOARD OF REVIEW
NAME:	CASE: PD-2017-05406
BRANCH OF SERVICE:  NAVY	SEPARATION DATE: 20081222

SUMMARY OF CASE: Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E4, Auxiliary Equipment Technician, medically separated for “chondromalacia patella, 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 - 20081001	VARD - 20091223	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chondromalacia Patella, Right Knee	5099-
5003	10%	Chondromalacia Patella, Right Knee	5260-
5010	10%	

20090812	
Chronic Right Knee Pain	Cat II	Right Knee Recurrent Subluxation	5257	20%		
Chronic Nausea	Cat III	GERD	7346	0%		
Obstructive Sleep Apnea	Cat III	Obstructive Sleep Apnea	6847	30%		
Organic Circadian Rhythm Sleep Disorder/Delayed Sleep Phase	Cat IV					
Obesity	Cat IV	No VA Placement	
Nicotine Dependence	Cat IV	No VA Placement	
Hyperlipidemia	Cat IV	No VA Placement	
COMBINED RATING: 10%	COMBINED RATING OF ALL VA CONDITIONS: 50%	

ANALYSIS SUMMARY:

Right Knee Chondromalacia Patella. According to the service treatment record (STR) and MEB narrative summary (NARSUM), the CI underwent right knee surgery in November 2000 and in April 2008 (debridement of patellofemoral chondromalacia, plicectomy and partial synovectomy). During the 20 August 2008 MEB examination (recorded on DD Forms 2807-1 and 2808), 4 months prior to separation, he reported right knee pain, and the examiner noted anterior knee effusion, tenderness, and painful range of motion (ROM) which was most severe at the endpoint of flexion. The MEB NARSUM examination, the same day, noted CI complaints of daily right anterior knee pain which increased with walking more than 250 yards, ascending or

descending stairs, and squatting or kneeling. Physical examination revealed suprapatellar edema and possible effusion with multiple healed surgical scars. Flexion was to 120 degrees (normal 140), with pain, and hyperextension was greater than 5 degrees. There was generalized tenderness but no crepitus or instability demonstrated with ROM or with patellar compression and patellofemoral lateral tracking.

At the 12 August 2009 VA Compensation and Pension (C&P) examination, 8 months after separation, the CI reported daily anterior and lateral left knee pain and numbness. Physical examination showed knee tenderness and pain at rest, and some patellar abnormality with knee clicking and snapping. Measured ROM after repetition was from 0-106 degrees, with painful motion but no additional limitations.

The panel directed attention to its rating recommendation based on the above evidence. The PEB rated the right knee condition 10%, analogously coded 5099-5003 (arthritis, degenerative), and listed “chronic right knee pain” as a related Category II condition, which is intrinsic to the rated condition and cannot be separately rated without pyramiding (VASRD §4.14); thus, it was appropriately subsumed under the same rating. The VA also rated the right knee condition 10%, dual coded 5260-5010 (leg, limitation of flexion of-arthritis, due to trauma), based on the C&P examination, citing painful or limited motion of a major joint or group of minor joints. Panel members agreed that while there was no compensable limitation of flexion or extension (5260 or 5261), there was evidence of painful motion with functional loss supporting a 10% rating (based on §4.59, §4.40 and §4.45). The panel 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: Chronic Nausea, Obstructive Sleep Apnea (OSA), Organic Circadian Rhythm Sleep Disorder/Delayed Sleep Phase, Obesity, Nicotine Dependence, and Hyperlipidemia. The panel’s main charge is to assess the fairness of the PEB determination that the contended conditions were not unfitting. Although the OSA was mentioned in the on limited duty reports, none of the conditions were implicated in the non-medical assessment. There was no performance-based evidence from the record that any of the conditions significantly interfered with satisfactory duty performance at separation. Obesity and nicotine dependence are conditions not constituting a physical disability, IAW DoDI 1332.38 and not ratable. After due deliberation, the panel concluded there was insufficient cause to recommend a change in the PEB fitness determination for any 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 nausea, sleep apnea, sleep disorder, obesity, nicotine and hyperlipidemia conditions, 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 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:

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.