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AF | PDBR | CY2012 | PD-2012-01734

Original file (PD-2012-01734.rtf) Auto-classification: Denied

RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME: XXXXXXXXXXXXXXXXXXXX CASE: PD-2012-01734

BRANCH OF SERVICE: mARINE cORPS BOARD DATE: 20150421

SEPARATION DATE: 20021130

SUMMARY OF CASE: Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E-3 (Motor Transport) medically separated for right knee condition. The condition could not be adequately rehabilitated to meet the physical requirements of her Military Occupational Specialty or satisfy physical fitness standards. She was placed on limited duty and referred for a Medical Evaluation Board (MEB). “Chronic knee pain” and “Grade IV chondromalacia of patella, right knee,” were forwarded to the Physical Evaluation Board (PEB) IAW SECNAVINST 1850.4E. No other condition was submitted by the MEB. The Informal PEB adjudicated “chronic right knee pain” as unfitting, rated 10% and noted that Grade IV chondromalacia of the patella with corresponding Grade IV chondromalacia of the lateral femoral condyle, right knee was related to the unfit condition. The CI made no appeals and was medically separated.

CI CONTENTION: “Grade IV chrondromalcia - Rt Knee/Chemical Burn to Rt Hand”

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 :

IPEB – Dated 20020920	VA* - (~1 Mos. Pre -Separation)
Condition	Code	Rating	Condition	Code	Rating	Exam
Chronic Right Knee Pain	5299-5003	10%	Residual Arthroscopic Surgery …w/ Degenerative Changes Patella Right Knee	5010-5262	20%	20021022
Grade IV Chondromalacia Right Knee / Lateral Femoral Condyle	Cat II
Other x 0	Other x 2 (Not in Scope)
RATING: 10%	RATING: 30%

* Derived from VA Rating Decision (VA RD ) dated 200 3 0923 (most proximate to date of separation [ DOS ] )

ANALYSIS SUMMARY:

Right Knee Condition. The evidence present for review supports that the CI had a right knee injury prior to service; however, she was asymptomatic throughout basic training and became symptomatic due to increased running at her first duty station. She also noted onset of knee locking and giving way due to pain. She was evaluated by orthopedics and treated with physical therapy (PT) and limited duty. A plain film X-ray revealed one or more bone spurs on the patella (the original report was not available for review). When her knee pain persisted, she underwent an arthroscopic procedure 7 months prior to separation. The pertinent operative findings were severe chondromalacia mainly on the lateral side of the patella and lateral femoral condyle which was down to eburnated (sclerotic) bone (note: eburnation is a change in exposed subchondral bone in degenerative joint disease in which it is converted into a dense substance with a smooth surface like ivory). Post-surgical PT did not resolve her pain and she was referred into the disability evaluation process. The narrative summary prepared 6 months prior to separation noted persistent right knee pain that began while on active duty while running inclines. At her post-operative visit, the treating orthopedic surgeon informed her that the severity of the chondromalacia of her knee joint would likely preclude her from returning to full duty. He suggested injection of the right knee with corticosteroid. He also advised that this would be a primarily palliative treatment and would not make her chronic right knee pain resolve. At the VA Compensation and Pension (C&P) exam performed a month prior to separation, the CI reported bad pain and locking and that sometimes the knee gave out. She had surgery where they found numerous bone spurs involving her right kneecap. The right kneecap was shaved, but after the operation she had not improved that much. A right knee X-ray revealed minimal degenerative change in the posterior patella.

The goniometric range-of-motion (ROM) evaluations in evidence which the Board weighed in arriving at its rating recommendation, with documentation of additional ratable criteria, are summarized in the chart below.

Right Knee ROM (Degrees)	PT ~8 Mo. Pre-Sep	NARSUM ~6 Mo. Pre-Sep	VA C&P ~1 Mo. Pre-Sep
Flexion (140 Normal)	140	110	130
Extension (0 Normal)	0	0	0
Comment	No instability; Pos. crepitus; Normal strength	Antalgic gait; Mild edema; No effusion	Antalgic gait; Pos. tenderness to palpation; No effusion; No instability
§4.71a Rating	10 %	10 % (PEB 10%)	10 % (VA 20%)

The Board directed attention to its rating recommendation based on the above evidence. The PEB applied the analogous VASRD code 5299-5003 (degenerative arthritis) and rated it 10%. After a Decision Review Officer (DRO) review, the VA increased the rating to 20% for the right knee condition coded as 5010 (arthritis due to trauma) with 5262 (impairment of the tibia and fibula) effective the day after separation. With the documented right knee crepitus, antalgic gait and painful motion, the evidence easily supports the 10% evaluation under code 5003. The Board considered the operative findings of severe chondromalacia involving the patella and lateral femoral condyle along with the CI’s knee pain, buckling, and giving out as additional evidence of greater impairment than that captured by the 10% rating. That additional disability can be appropriately rated under VASRD code 5262 as applied by the VA’s DRO based on the C&P exam performed a month prior to separation. The rating levels for code 5262 are based on the subjective determination of slight (10%), moderate (20%), or marked (30%) knee disability. There was no evidence of instability or recurrent effusion that would be required for application of the marked knee disability rating. The 10% rating would confer no benefit to the CI. Additionally, VASRD §4.7 states, “Where there is a question as to which of two evaluations shall be applied, the higher evaluation will be assigned if the disability picture more nearly approximates the criteria required for that rating. Otherwise, the lower rating will be assigned.” After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the Board recommends a disability rating of 20% for the chronic right knee pain 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 chronic right knee pain condition, the Board unanimously recommends a disability rating of 20%, coded 5010-5262 IAW VASRD §4.71a. There were no other conditions within the Board’s scope of review for consideration.

RECOMMENDATION: The Board recommends that the CI’s prior determination be modified as follows, effective as of the date of her prior medical separation:

CONDITION	VASRD CODE	RATING
Chronic Right Knee Pain with related Grade IV Chondromalacia of the Patella with Corresponding Grade IV Chondromalacia of the Lateral Femoral Condyle	5010-5262	20%
COMBINED	20%

The following documentary evidence was considered:

Exhibit A. DD Form 294, dated 20120811 w/atchs
Exhibit B. Service Treatment Record

Exhibit C. Department of Veterans Affairs Treatment Record

XXXXXXXXXXXXXXX
President
DoD Physical Disability Board of Review

ME MORANDUM FOR COMMANDER, NAVY PERSONNEL COMMAND
DEPUTY COMMANDANT, MANPOWER & RESERVE AFFAIRS

Subj: PHYSICAL DISABILITY BOARD OF REVIEW (PDBR) RECOMMENDATIONS

Ref:     (a) DoDI 6040.44
(b) PDBR ltr dtd 24 Jun 15 ICO XXXXXXXXXXXXXXXXXX
(c) PDBR ltr dtd 19 Jun 15 ICO XXXXXXXXXXXXXXXXXX
(d) PDBR ltr dtd 12 May 15 ICO XXXXXXXXXXXXXXXXXX
(e) PDBR ltr dtd 9 Jun 15 ICO XXXXXXXXXXXXXXXXXX

1. Pursuant to reference (a) I approve the recommendations of the Physical Disability Board of Review set forth in references (b) through (e).

2. The official records of the following individuals are to be corrected to reflect the stated disposition:

a.       XXXXXXXXXXXXXXXXXXXX, former USN: Entitlement to disability severance pay with a disability rating of 20 percent (increased from 10 percent) effective date of discharge.

b. XXXXXXXXXXXXXXXXXXXX, former USMC: Entitlement to disability severance pay with a disability rating of 20 percent (increased from 10 percent) effective date of discharge.

c. XXXXXXXXXXXXXXXXXXXX, former USN: Placement on the Permanent Disability Retired List with a 30 percent disability rating (increased from 20 percent) effective date of discharge.

d. XXXXXXXXXXXXXXXXXXXX, former USN: Entitlement to disability severance pay with a disability rating of 10 percent (increased from 0 (zero) percent) effective date of discharge.

3. Please ensure all necessary actions are taken to implement these decisions, including the recoupment of disability severance pay, if warranted, and notification to the subject members once those actions are complete.

XXXXXXXXXXXXXXXXXXXX
Assistant General Counsel
(Manpower & Reserve Affairs)

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AF | PDBR | CY2012 | PD-2012-01734

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