RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME: XXXXXXXXXXXXXXXXXXXX	CASE:  PD-2014-01760
BRANCH OF SERVICE:  MARINE CORPS	BOARD DATE:  20141230
SEPARATION DATE:  20040831

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E-3 (Administrative Clerk) medically separated for chondromalacia of the left knee.  The condition could not be adequately rehabilitated to meet the physical requirements of his Military Occupational Specialty.  He was placed on limited duty and eventually referred for a Medical Evaluation Board (MEB).  The knee condition, characterized as “grade IV chondromalacia of the left knee” was the only condition forwarded to the Physical Evaluation Board (PEB) IAW SECNAVINST 1850.4E.  The Informal PEB adjudicated “grade IV chondromalacia of the left knee” as unfitting, rated 10% with likely application of the VA Schedule for Rating Disabilities (VASRD).  The CI made no appeals and was medically separated.

CI CONTENTION:  “Please Consider All Conditions.”

SCOPE OF REVIEW:  The Board’s scope of review is defined in DoDI 6040.44, Enclosure 3, paragraph 5.e.(2).  It is limited 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 PEB, but determined to be not unfitting.  Any conditions outside the Board’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/Naval Records.  Furthermore, the Board’s authority is limited to assessing the fairness and accuracy of PEB rating determinations and recommending corrections, where appropriate.  The Board’s assessment of the PEB rating determinations is confined to review of medical records and all available evidence for application of the Veterans Affairs Schedule for Rating Disabilities (VASRD) standards to the unfitting medical condition at the time of separation.  The Board 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, operating under a different set of laws.  The Board gives consideration to VA evidence, particularly within 12 months of separation, but only to the extent that it reasonably reflects the severity of the disability at the time of separation. 

RATING COMPARISON:

Service IPEB – Dated 20040712 | VA - (14.5 Mos. Pre/Post-Separation)
Condition | Code | Rating | Condition | Code | Rating | Exam

Grade IV Chondromalacia of the Left Knee

5099-5003

10%

Status Post Multiple Left Knee Arthroscopic Surgeries
with Residual Grade IV Chondromalacia /Internal
Derangement of the Left Knee(No Current Disability, or
an Actual Disabling Condition)

5299-5014

0%

20050119

Other x 0 (Not In Scope) | Other 4
Combined:  10% | Combined:  0%
Derived from VA Rating Decision (VARD) dated 20050321 (most proximate to date of separation [DOS]).
ANALYSIS SUMMARY:

Grade IV Chondromalacia of the Left Knee.  The CI reported pre-service left knee injury secondary to high school wrestling incident that was addressed by left knee lateral release surgery (patella) in March 2000.  The narrative summary (NARSUM) recorded the CI sustained an additional injury to his left knee in October 2002 while marching.  Radiographs in October 2002 demonstrated mild to moderate degenerative joint disease.  The CI reported persistent pain, knee locking and popping, and denied instability.  He underwent a second surgery in November 2002 with a partial debridement of his meniscus.  The CI participated in physical therapy for approximately 9 months; however, continued with persistent pain, diagnosed as painful and inflammatory plica.  In February 2003, he had the plica excised and was informed that he had significant cartilage damage and chrondromalacia in the knee.  Having failed conservative measures and treatment of his pain, the CI was referred to the MEB.  At the NARSUM examination dated 12 May 2004, approximately 3 months prior to separation, the CI noted he was unable to run for any significant amount of distance, could not complete his physical fitness test and had difficulty going on long walks with his family.  He noted that when his children jumped on his knee, he had significant pain.  Physical examination noted well-healed arthroscopy scar, and no evidence of inflammation.  Left knee range-of-motion (ROM) recorded 130 degrees of flexion (145), and no evidence of instability, or neurovascular examination compromise.  He had a significantly positive patellar grind.

The VARD noted a Compensation and Pension examination was conducted on 24 February 2005.  The VARD recorded there was absence of pain at rest, absence of knee instability and there were occasional episodes of swelling and stiffness with prolonged activity that also increased pain.  The VA opined the evidence cited by the examining physician did not show an actual disabling condition that would warrant a compensable evaluation.

The Board directed attention to its rating recommendation based on the above evidence.  The PEB and VA chose different coding options for the condition, but this did not bear on the rating.  The PEB’s 10% determination coded analogously 5003, was consistent with clinical findings of slight limitation of motion, which was not compensable under any ROM codes.  The Board agreed that a route to a higher rating under 5257 (knee, other impairment of) was not supported by the evidence.  There was likewise no history of dislocated semilunar cartilage to warrant a rating under the 5258 code.  After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the Board concluded that there was insufficient cause to recommend a change in the PEB adjudication for the left knee chondromalacia condition.

BOARD FINDINGS:  IAW DoDI 6040.44, provisions of DoD or Military Department regulations or guidelines relied upon by the PEB will not be considered by the Board to the extent they were inconsistent with the VASRD in effect at the time of the adjudication.  The Board did not surmise from the record or PEB ruling in this case that any prerogatives outside the VASRD were exercised.  In the matter of the chondromalacia of the left knee condition and IAW VASRD §4.71a, the Board unanimously recommends no change in the PEB adjudication.  There were no other conditions within the Board’s scope of review for consideration.

RECOMMENDATION:  The Board, therefore, recommends that there be no re-characterization of the CI’s disability and separation determination.

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20140424, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans’ Affairs Treatment Record

				
XXXXXXXXXXXXXXXXXXXX
President
DoD Physical Disability Board of Review

MEMORANDUM FOR DIRECTOR, SECRETARY OF THE NAVY COUNCIL OF REVIEW BOARDS
Subj:	PHYSICAL DISABILITY BOARD OF REVIEW (PDBR) RECOMMENDATION 
Ref:	(a) DoDI 6040.44
(b) CORB ltr dtd 10 Jun 15

In accordance with reference (a), I have reviewed the cases forwarded by reference (b), and, for the reasons provided in their forwarding memorandums, 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:

-	XXXXXXXXXXXXXXXXXXXX, former USMC
-	XXXXXXXXXXXXXXXXXXXX, former USMC
-	XXXXXXXXXXXXXXXXXXXX, former USN
-	XXXXXXXXXXXXXXXXXXXX, former USN
-	XXXXXXXXXXXXXXXXXXXX, former USN

XXXXXXXXXXXXXXXXXXXX
Assistant General Counsel (Manpower & Reserve Affairs)

PD-2014-01760