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AF | PDBR | CY2012 | PD 2012 00704
Original file (PD 2012 00704.rtf) Auto-classification: Denied
RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME: XXXXXXXXXXXXXXX    CASE: PD-2012-00704
BRANCH OF SERVICE: MARINE CORPS          BOARD DATE: 20140930
SEPARATION DATE: 20020315


SUMMARY OF CASE: Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty LCPL/E-3 (7051/Aircraft Rescue and Firefighting Specialist) medically separated for a left knee condition. The condition could not be adequately rehabilitated to meet the physical requirements of his Military Occupational Specialty (MOS) or satisfy physical fitness standards. He referred for a Medical Evaluation Board (MEB). The MEB forwarded “left patellofemoral pain syndrome” to the Physical Evaluation Board (PEB) for fitness consideration. No other conditions were submitted by the MEB. The PEB adjudicated “left patellofemoral syndrome” as unfitting, rated at 10%. The CI made no appeals and was medically separated.


CI CONTENTION: “Hearing loss is continuing to deteriorate and back is starting to be affected by worsening of knee. Hips are also being affected by knee”.


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. The contended hearing, back and hip conditions were not referred by the MEB nor considered by the PEB and are therefore not 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 20020123
 VA - (~2 Mos. Pre-Separation)
Condition
 Code Rating Condition Code Rating Exam
Left PFS 5299-5003 10% PFPS Left 5014 10% 20020128
Other x 0 (not in scope)
 Other x 2 20020128
Combined: 10%
 Combined: 20%
* Derived from VA Rating Decision (VA RD ) dated 200 20404 (most proximate to date of separation )


ANALYSIS SUMMARY: The Board acknowledges the CI’s information regarding the significant impairment with which his service-connected condition continues to burden him; but must emphasize that the Disability Evaluation System has neither the role nor the authority to compensate members for anticipated future severity or potential complications of conditions resulting in medical separation. That role and authority is granted by Congress to the Department of Veterans Affairs, operating under a different set of laws. Post-separation evidence is probative to the Board’s recommendations only to the extent that it reasonably reflects the disability at the time of separation.

Left Knee Condition. Service treatment records contain documentation that the CI hyperextended his left knee in a fall during training. X-ray images of left knee obtained 29 December 1999, was normal. He was managed conservatively and returned to full duty until he reinjured himself while running. A physical examination dated 26 March 2001; the examiner noted that the CI’s left knee was remarkable for diffuse joint tenderness and testing for meniscal (cartilage cushions in the knee joint) irritation was positive. The left knee range-of-motion (ROM) was normal and the stable without swelling.

The MEB narrative summary (NARSUM) dated 22 October 2001; the CI reported a 2 year history of left anterior knee pain after falling. The CI stated that his knee occasionally swelling and giving way, but denied mechanical symptoms (such as clicking, catching, or locking). His left knee symptoms persisted despite extensive physical therapy and activity modification. During physical examination, the examiner noted left knee tenderness at the medial joint line and with patellar compression. There was mild crepitus (a grating, crunching, or crackling sound or sensation) at the patella-femoral joint with ROM and pain with full flexion. The [left] knee was stable. A left knee magnetic resonance imaging revealed no ligamentous damage or meniscal tears (suspected from the 26 March 2001 examination.) The diagnosis was listed as left patella-femoral syndrome (PFS).

At the VA Compensation and Pension (C&P) examination dated 28 January 2002 (2 months prior to separation), the CI complained of constant left knee pain, exacerbations by prolonged walking and standing in excess of an hour. While no active treatment was reported, the CI indicated that symptoms were relieved by application of ice, small amounts of Tylenol and sitting. He complained of an approximately 40% loss in strength of his left leg with associated left knee swelling, frequent sensation of giving way and locking approximately once every other week. The CI reported that he could no longer do vigorous physical activity. He denied a history of surgery, inflammatory arthritis, dislocation, or recurrent subluxation (an incomplete dislocation). The examiner noted that the CI had a normal posture, gait and did not use an assistive device. Physical examination revealed no callosities, breakdown, or unusual shoe wear patterns. The knee was stable and normal to examination other than an equivocal test for meniscal irritation limited by discomfort. Bilateral knee ROM was recorded as 0 degrees to 130 degrees of flexion and full extension. Limitations resulting from pain, fatigue, weakness, or lack of endurance with repetition (DeLuca criteria) were not evident. The diagnosis was listed as left PFS. The X-ray images of left knee dated 28 January 2002 showed findings that may represent early degenerative change.

The Board directed attention to its rating recommendation based on the above evidence. The PEB rated the left knee condition at 10% under VASRD code 5299-5003 (analogy-degenerative arthritis). The VA rated the left knee condition at 10% under VASRD code 5014 (osteomalacia) citing limited motion and degenerative changes by X-ray. The joint motion documented in examinations did not attain a minimum rating under VASRD diagnostic code 5260 (limitation of flexion) or 5261 (limitation of extension). There was no dislocated meniscus for consideration under 5258 (dislocated meniscus with frequent episodes of locking). There was no instability for rating consideration under 5257 (recurrent subluxation or instability). There was no ankylosis of the knee for consideration under 5256 (knee, ankylosis of). Board members agreed that there was sufficient evidence of pain with use prior to separation, as well objective examination and imaging findings, to support a 10% rating considering functional loss and painful motion (§4.40, §4.59); however, no route to a higher rating was found. 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. 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 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 20120607, w/atchs
Exhibit B. Service Treatment Record
Exhibit C. Department of Veterans’ Affairs Treatment Record



                 
XXXXXXXXXXXXXXX
President
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 11 Mar 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:
- XXXXXXXXXXXXXXX, former USMC
- XXXXXXXXXXXXXXX, former USMC
- XXXXXXXXXXXXXXX, former USN
- XXXXXXXXXXXXXXX, former USMC
- XXXXXXXXXXXXXXX, former USN


                                                      XXXXXXXXXXXXXXX
                                            Assistant General Counsel
                  (Manpower & Reserve Affairs)

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