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AF | PDBR | CY2012 | PD2012 00868
Original file (PD2012 00868.rtf) Auto-classification: Denied
RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME: XX         CASE: PD1200868
BRANCH OF SERVICE: MARINE CORPS  BOARD DATE: 20130507
SEPARATION DATE: 20030430


SUMMARY OF CASE: Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty Cpl/E-4 (3533/Vehicle Operator) medically separated for a left knee condition. He injured his knee in April 2001. Despite surgery and physical therapy, the left knee condition could not be adequately rehabilitated to meet the physical requirements of his Military Occupational Specialty or satisfy physical fitness standards. He was placed on limited duty and referred for a Medical Evaluation Board (MEB). The knee condition, characterized as left anterior knee pain/tibial tubercle apotheosis/peripatellar tendonitis, and pes anserine tendonitis (resolved), were forwarded to the Physical Evaluation Board (PEB) IAW SECNAVINST 1850.4E. No other conditions were submitted by the MEB. The PEB adjudicated left anterior knee pain/tibial tubercle apophysitis/peripatellar tendonitis status post (s/p) tibial tubercle apophysis debridement as unfitting, rated 10%, with application of the Veterans Affairs Schedule for Rating Disabilities (VASRD). The PEB adjudicated the left pes anserine tendonitis resolved as Category III, a condition that is not separately unfitting and does not contribute to the unfitting condition. The CI made no appeals, and was medically separated with a 10% disability rating.


CI’s 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 20030304
 VA - (1 Mo. Pre-Separation)
Condition
 Code Rating Condition Code Rating Exam
Left Anterior Knee Pain, Tibial Tubercle Apophysitis, Peripatellar Tendonitis, s/p Tibial Tubercle Apophysis Debridement 5299-5003 10% Residuals, Post-operative Left Tibial Tubercle Ossicle with Patellar Tendinitis 5262-5024 10% 20030317
Scar, Left Knee 7804 10% 20030317
Left Pes Anserine Tendonitis, Resolved Category III No VA Entry
No Additional MEB/PEB Entries
 Other x 1 20030317
Combined: 10%
 Combined: 20%
Derived from VA Rating Decision (VA RD ) dated 200 30501 ( most proximate to date of separation [ DOS ] ).



ANALYSIS SUMMARY:

Left Knee Pain. This Marine has a long history of left knee pain, dating back to the 2000/2001 timeframe. X-ray revealed bony ossicles at the left tibial tubercle. In April 2002, he underwent surgical debridement of the left tibial tubercle apophysis. Postoperatively, he continued to have knee pain and an MEB was initiated. The MEB physical examination (pe)of the left knee was in December 2002. There was some tenderness to palpation (TTP), but no effusion. Range-of-motion (ROM) was normal. On 17 March 2003, the CI had a VA Compensation and Pension (C&P) exam. Gait and posture were normal. PE of the left knee revealed no erythema, swelling, effusion or increased warmth. There was TTP over the tibial tuberosity, as well as the infrapatellar region. Drawer test and McMurray’s test were both normal. ROM was measured, and is summarized in the chart below. ROM was not additionally limited by pain, fatigue, weakness, lack of endurance, or incoordination. The two ROM evaluations which the Board weighed in arriving at its rating recommendation are summarized in the chart below.

Left Knee ROM
 MEB ~ 4 mos . Pre-Sep
(200 21220 )
VA C&P ~ 1½ mos . Pre- Sep
(200 30317 )
Flexion (140 ⁰ is n ormal)
 140 ⁰ 120 ⁰
Extension (0 ⁰ is n ormal)
 0⁰ 0 ⁰
§4.71a Rating
 10% * 10% *
*10% based on VASRD §4.40 (Functional loss) , and §4.4 5 ( The joints )

The Board carefully reviewed all evidentiary information available and 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 Board determined that the left knee condition was essentially non-compensable based solely on VASRD §4.71a codes for loss of knee motion (5260 and 5261). However; IAW VASRD §4.40 (functional loss), a part of the musculoskeletal system which becomes painful on use must be regarded as seriously disabled. After due deliberation, the Board agreed that a separation disability rating of 10% was warranted. 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 record did not show sufficient evidence of a disabling knee abnormality which would justify a rating higher than 10%. After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (resolution of reasonable doubt), the Board concluded that there was insufficient cause to recommend a change in the PEB adjudication for the unfitting left 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. In the matter of the left knee pain, and IAW VASRD §4.40, §4.45 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
Left Knee Condition 5299-5003 10%
COMBINED
 10%


The following documentary evidence was considered:

Exhibit A. DD Form 294, dated 20120611, 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 31 May 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 USN
- X former USN
- X former USN



                                                     
                                                     Assistant General Counsel
                                                      (Manpower & Reserve Affairs)

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