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AF | PDBR | CY2012 | PD2012 01167
Original file (PD2012 01167.rtf) Auto-classification: Denied
RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME: XX         CASE: PD1201167
BRANCH OF SERVICE: NAVY  BOARD DATE: 20130425
SEPARATION DATE: 20040202


SUMMARY OF CASE: Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty CM3/E-4 (CM3/Construction Mechanic Third Class) medically separated for a left knee condition. The CI began experiencing gradual onset of pain in his left knee in August of 2000. He was diagnosed with patellofemoral syndrome and began a regime of conservative treatment. He continued his treatment plan in orthopedics and was eventually diagnosed with chondromalacia and was scheduled for surgery in July of 2003. The CI had to cancel his surgery due to emergency leave. He returned to orthopedics for reevaluation and it was determined that he would no longer benefit from surgery. The condition could not be adequately rehabilitated to meet the physical requirements of his rating or satisfy physical fitness standards. He was placed on limited duty and referred for a Medical Evaluation Board (MEB). The left knee condition, characterized as chondromalacia of patella, left knee was forwarded to the Physical Evaluation Board (PEB) IAW SECNAVINST 1850.4E. No other conditions were submitted by the MEB. The Physical Evaluation Board (PEB) adjudicated chrondromalacia patella, left knee as unfitting, rated 10%. The CI made no appeals, and was medically separated.


CI CONTENTION: “Due to my conditions worsening, and having not considered my dislocated left shoulder or left foot stress fractures at the time of my PDBR.”


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 those conditions identified but not determined to be unfitting by the PEB when specifically requested by the CI. The rating for the unfitting left knee condition is addressed below; and, no additional conditions are within the DoDI 6040.44 defined purview of the Board. Any conditions or contention not requested in this application, or otherwise outside the Board’s defined scope of review, remain eligible for future consideration by the Board for Correction of Naval Records.


 RATING COMPARISON :

Service IPEB – Dated 20031024
 VA - (STR)
Condition
 Code Rating Condition Code Rating Exam
Chondromalacia of the Patella, Left Knee 5299-5003 10% Chondromalacia of the Patella, Left Knee 5099-5014 0% *STR
Combined: 10%
 Combined: 0%
Derived from VA Rating Decision (VA RD ) dated 200 60428 ( most proximate to date of separation [ DOS ] ).
*The CI failed to show up for his original VA Rating Exam. The CI did attend a VA C&P Exam for Joints on 20041026, 8 months after his DOS. A Decision Review Officer Decision (DROD) dated 20041117, 9 months after his DOS did not increase the rating for his left knee.



ANALYSIS SUMMARY: The Board acknowledges the implied sentiment expressed by the CI regarding the impairment with which his conditions continue to burden him, and the impact they have had on his quality of life. It is noted for the record that the Board is subject to the same laws for Service disability entitlements as those under which the Disability Evaluation System (DES) operates. The DES has neither the role nor the authority to compensate members for future severity or potential complications of conditions. That role and authority is granted to the Department of Veterans Affairs (DVA). The Board evaluates DVA evidence in arriving at its recommendations, but its authority resides in evaluating the fairness of DES fitness and rating determinations at the time of separation. While the DES considers all of the CI's medical conditions, compensation can only be offered for those conditions that cut short a member’s career, and then only to the degree of severity present at the time of separation. The DVA, however, is empowered to compensate for service connected conditions and to periodically re-evaluate conditions for the purpose of adjusting the Veteran’s disability rating should the degree of impairment change over time.

Left knee pain. In July 2000, the CI jumped from a causeway and injured his knee. He developed left knee pain that occurred after running. Conservative management brought little relief. Magnetic resonance imaging performed in November 2001 showed a medial meniscus tear. Due to persistent problems with left knee pain, an MEB was initiated. The MEB clinical evaluation was on 24 July 2003. On exam, the left knee was stable to varus and valgus stress. There was minimal joint line tenderness and a negative McMurray’s test. Range-of-motion (ROM) testing revealed full extension of his knee, and flexion to 125 degrees. The diagnosis on the MEB narrative summary was chondromalacia of patella, left knee. As noted above, the CI was separated from the Navy on 2 February 2004. After separation, he was scheduled for a VA Compensation and Pension exam, but he failed to report.

The Board directs attention to its rating recommendation based on the above evidence. The Navy PEB and the VA chose different coding and rating options for the left knee condition. The PEB coded it 5299-5003 and assigned a rating of 10%. The VA used code 5099-5014, and rated it 0% based on the service treatment record. The CI’s left knee condition was essentially non-compensable based solely on the Veteran’s Administration Schedule for Rating Disabilities (VASRD) §4.71a codes for loss of knee motion (5260 & 5261). However; IAW VASRD §4.40, §4.45, and §4.59, a 10% rating is warranted when there is satisfactory evidence of functional limitation due to painful motion of a major joint. The Board tried to find a path to a rating higher than 10%, using other codes which could be applied to the left knee condition. The other VASRD codes that were considered did not result in a higher rating, since the STR did not show evidence of a significantly disabling joint abnormality which would justify a rating higher than 10%. 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 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. In the matter of the left knee condition and IAW VASRD §4.40, §4.45, §4.59, and §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 recharacterization of the CI’s disability and separation determination, as follows:

UNFITTING CONDITION
 VASRD CODE RATING
Chondromalacia of Patella, Left Knee 5299-5003 10%
COMBINED
 10%


The following documentary evidence was considered:

Exhibit A. DD Form 294, dated 20120715, w/atchs
Exhibit B. Service Treatment Record
Exhibit C. Department of Veterans’ Affairs Treatment Record





         XX
         Director of Operations
         Physical Disability Board of Review
MEMORANDUM FOR DIRECTOR, SECRETARY OF THE NAVY COUNCIL OF REVIEW
BOARDS

Subj: PHYSICAL DISABILITY BOARD OF REVIEW (PDBR) RECOMMENDATIONS

Ref: (a) DoDI 6040.44
(b) CORB ltr dtd 12 Jun 13

In accordance with reference (a), I have reviewed the cases forwarded by reference (b), and, for the reasons provided in their forwarding memorandum, 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:
- x former USMC
- x former USN
- x former USMC
- x former USMC
- x former USMC
- x former USMC
- x former USMC
- x former USN



                                                      xx
                                            Assistant General Counsel
                                                      (Manpower & Reserve Affairs)

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