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AF | PDBR | CY2012 | PD-2012-01921
Original file (PD-2012-01921.rtf) Auto-classification: Denied
RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME: XXXXXXXXXXXXXXX    CASE: PD-2012-01921
BRANCH OF SERVICE: MARINE CORPS  BOARD DATE: 20130703
SEPARATION DATE: 20021215


SUMMARY OF CASE: Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty LCpl/E-3 (6316/Aviation technician) medically separated for a chronic left knee condition. He presented to the orthopedic clinic with persistent knee pain in March 2000 which developed during boot camp training; and did not improve adequately with conservative measures to meet the physical requirements of his Military Occupational Specialty (MOS) 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 “left patellofemoral pain with secondary chronic left knee pain,” was forwarded to the Physical Evaluation Board (PEB) IAW SECNAVINST 1850.4E. The MEB also identified and forwarded history of cellulitis, left knee, chronic bilateral hip pain secondary to bilateral iliotibial band friction syndrome, chronic mechanical low back pain, mild (less than a centimeter) left shorter than right limb length discrepancy, and mild bilateral pes planus conditions. The PEB adjudicated “left patellofemoral pain with secondary chronic left knee pain” as unfitting, rated 10%, with likely application of the Veterans Affairs Schedule for Rating Disabilities (VASRD). The remaining conditions were determined to be Category III (not separately unfitting and do not contribute to the unfitting condition). The CI made no appeals, and was medically separated.


CI CONTENTION: The CI elaborated no specific contention in his application.


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 20020918
 VA - (3 Mos. Post-Separation)
Condition
 Code Rating Condition Code Rating Exam
Left Patellofemoral Pain With Secondary Chronic Left Knee Pain
 5299-5003 10% Patellofemoral Pain Syndrome, Left Knee 5260 NSC* 20030212
Chronic Bilateral Hip Pain
 CAT III Synovitis Right Hip 5252-5020 0% 20030212
Synovitis, Left Hip 5252-5020 0% 20030212
Chronic Mechanical Low Back Pain
 CAT III Low Back Syndrome w/Disc Narrowing at L5 to S1 5295 10% 20030212
Mild Left Shorter Than Right Limb Length Discrepancy
 CAT III Shortened Left Lower Extremity NSC
Mild Bilateral Pes Planus
 CAT III Bilateral Pes Planus NSC
History of Cellulitis, Left Knee
 CAT III Cellulitis Left Knee NSC
No Additional MEB/PEB Entries
 Other x 1
Combined: 10%
 Combined: 20%
Derived from VA Rating Decision (VA RD ) dated 20030507 ( most proximate to date of separation [ D OS ] ). * Deferred from VARD 20030507 and determined to be “NSC” per 20030606 VARD .


ANALYSIS SUMMARY: IAW DoDI 6040.44, the Board’s authority is limited to making recommendations on correcting disability determinations. The Board’s role is thus confined to the review of medical records and all evidence at hand to assess the fairness of PEB rating determinations, compared to VASRD standards, based on ratable severity at the time of separation; and, to review those fitness determinations within its scope (as elaborated above) consistent with performance-based criteria in evidence at separation.

Left Patellofemoral Pain. The CI experienced a rapid onset of left knee pain and swelling during boot camp after completing Crucible training, where he also sustained bilateral knee abrasions and lacerations. He was hospitalized in January 2001 for 2 days and treated with antibiotics for presumptive cellulitis of the left lower extremity. The CI subsequently complained of pain on running and “the longer the run the more severe the pain,” as well as mild swelling after long runs. X-rays of the left knee were normal. An orthopedic surgery consultation in July 2001 to evaluate his complaint of persistent knee pain found normal left patella excursion, positive patellar grind, retropatellar tenderness, tenderness over the medial femoral condyle, and questionable, palpable plica. The McMurray test was negative for meniscal tear, but there was compression type pain during the test. The knee ligaments were stable. Magnetic resonance imaging showed no evidence of a left knee meniscal or cruciate ligament tear. Collateral ligaments were intact and a small joint effusion was noted. A bone scan revealed no abnormalities. The narrative summary (NARSUM) dictated on 2 April 2002 (8 months prior to separation) reported persistence of the left knee pain despite physical therapy and anti-inflammatory medications; he was not taking any medication at the time of the NARSUM. Physical exam of the left knee found diffuse tenderness, without effusion or edema. Patellar mobility was normal, with positive patellar grind and patellar compression pain. There was tenderness over the medial and lateral femoral condyles and joint lines. Alignment was normal. There was no evidence of ligamentous laxity, with negative Lachman and varus and valgus stress tests. Steinmann, McMurray, and Flick tests produced diffuse knee pain, although those maneuvers were not consistent with meniscal pathology. There was negative apprehension. Lower extremity muscle strength was 5/5 (normal) bilaterally. The patellar tendon reflex was mildly decreased on the left. Range-of-motion (ROM) was “full and symmetrical without pain.” There was no lateral patellar deviation with knee extension and no limb length discrepancy. Laboratory studies were normal. The diagnosis was left knee pain secondary to patellofemoral syndrome. The separation medical exam in May 2002 found tenderness over the left anterior medial and posterior patella, positive patellar grind and apprehension, and a small effusion. Crepitus was noted in both knees. Anterior and posterior drawer and McMurray tests were negative for cruciate ligament and meniscal injury. Full ROM was noted. At a Compensation and Pension (C&P) exam in February 2003 (2 months after separation), the CI complained that his left knee “locks and pops.” Pain behind the knee cap was occasional, and he denied giving way. Examination noted medial tenderness, no instability and a negative McMurray’s sign. ROM was “normal.” At a second C&P exam in May 2003 (5 months after separation), the CI reported some discomfort when bearing weight or going up and down stairs, occasional swelling and a tendency to give way. Physical exam found normal ROM (0-140 degrees) and normal gait. Mild tenderness to deep palpation of the medial femoral epicondyle was noted. McMurray and drawer tests were negative. The patella was stable and there was no retropatellar crepitus or pain with patellar compression. Some atrophy of the left quadriceps muscle was present. X-rays of the left knee were normal. The examiner noted no evidence of patellofemoral syndrome.

The Board directs attention to its rating recommendation based on the above evidence. The PEB assigned a 10% rating under an analogous 5003 code (degenerative arthritis). The VA denied service-connection for patellofemoral pain syndrome. Although examinations consistently showed no limitation of motion, a 10% rating was reasonably conceded with application of VASRD §4.59 (Painful motion). There was no ankylosis, recurrent subluxation or lateral instability, or malunion to justify a compensable rating using codes 5256 (knee, ankylosis of), 5257 (knee, other impairment of), or 5262 (tibia and fibula, impairment of), respectively. The Board unanimously agreed that this case supports a rating of 10% IAW VASRD §4.59 (Painful motion) at the time of separation. 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 patellofemoral 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 left patellofemoral pain 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 recharacterization of the CI’s disability and separation determination, as follows:

UNFITTING CONDITION VASRD CODE RATING
Left Patellofemoral Pain 5299-5003 10%
COMBINED 10%



The following documentary evidence was considered:

Exhibit A. DD Form 294, dated 20121120, 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) RECOMMENDATION
Ref:     (a) DoDI 6040.44
(b) CORB ltr dtd 2 May 14

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 USMC
-        XXXXXXXXXXXXXXXXXXXX , former USMC
-        XXXXXXXXXXXXXXXXXXXX, former USMC






XXXXXXXXXXXXXXXXXXXX
Assistant General Counsel (Manpower & Reserve Affairs)

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