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AF | PDBR | CY2012 | PD2012 01247
Original file (PD2012 01247.rtf) Auto-classification: Denied
RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME: xx         CASE: PD1201247
BRANCH OF SERVICE: NAVY  BOARD DATE: 20130521
SEPARATION DATE: 20020823


SUMMARY OF CASE: Data extracted from the available evidence of record reflects that this covered individual (CI) was a Reserve Lieutenant, LT/O-3 (0862/Industrial Hygiene Officer) medically separated for a left knee condition. While attending Officer Indoctrination School, in 1998, the CI was walking; she stepped into a hole and sustained a twisting injury to her left knee. The CI received a full duty endorsement in May 2001 based on her Limited Duty Board and an extension on 18 May 2000 and 25 October 2000 respectively. On a follow-up evaluation, 12 April 2002, CI complained of persistent chronic left anterior knee pain. The left knee condition could not be adequately rehabilitated to meet the physical requirements of her rating or satisfy physical fitness standards. She was placed on limited duty (LIMDU) and referred for a Medical Evaluation Board (MEB). The left knee condition, characterized as chronic anterior knee pain, status post (s/p) left knee arthroscopic lateral retinacular release for lateral patellar compression syndrome was forwarded to the Physical Evaluation Board (PEB) IAW SECNAVINST 1850.4E. The MEB also identified and forwarded two other conditions for PEB adjudication, identified on the chart below. The PEB adjudicated chronic anterior knee pain, s/p left knee arthroscopic lateral retinacular release for lateral patellar compression syndrome as unfitting, rated 10% with likely application of SECNAVINST 1850.4E/Veterans Affairs Schedule for Rating Disabilities (VASRD). The remaining conditions , coxa saltans of the left hip and left greater trochanteric bursitis were determined to be Category III, conditions that are not separately unfitting and do not contribute to the unfitting condition. The CI made no appeals, and was medically separated .


CI CONTENTION: “Per VA Letter dated 25 MAY 2012, eligible for PDBR (I) Separated during the period beginning on September 11, 2001 and ending on December 31, 2009: Separated on 23 AUG 2002; (2) Found unfit for continued military service by a physical evaluation board with a disability rating of 20 percent or less: 10% Disability Rating; and (3) Found not eligible for Retirement: 0-3 with 7 Years (credit for prior service).” The CI elaborated no specific contention in her 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 within the DoDI 6040.44 defined purview of the Board and is addressed below. 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 20020705
 VA - (~1 Mo. Post-Separation)
Condition
 Code Rating Condition Code Rating Exam
Chronic Anterior Knee Pain, Status Post Left Knee Arthroscopic Lateral Retinacular Release for Lateral Patellar Compression Syndrome
 5299-5003 10% Left Knee Condition 5257 0% 20021127
Coxa Saltans of the Left Hip
 CAT III Bursitis, Left Hip 5019 10% 20021127
Left Greater Trochanteric Bursitis
 CAT III
No Additional MEB/PEB Entries
 0% x 2/Other x 4 20021127
Combined: 10%
 Combined: 50%
Derived from VA Rating Decision (VA RD ) dated 200 0606 ( most proximate to date of separation [ DOS ] ).


ANALYSIS SUMMARY:

Chronic Anterior Knee Pain, Status Post Left Knee Arthroscopic Lateral Retinacular Release for Lateral Patellar Compression Syndrome Condition. The narrative summary notes the CI injured her left knee in 1998. Following a trial of conservative therapy, she underwent a left knee arthroscopic surgery for lateral patellar compression syndrome in May 1999. Following the procedure she continued to experience swelling and pain of the knee with activity. No further surgery was recommended. A pain management consult considered that the pain may be a complex regional pain syndrome (CRPS) variant. The pain specialist also noted magnetic resonance imaging of the knee showed a small effusion but was otherwise normal. Ortho notes indicate continued CPRS diagnosis in the service treatment record (STR); however the CRPS resolved and the CI was gradually returned to full duty. While running a mock physical readiness training in October 2001, the CI experienced increased knee and new hip pain. Despite additional conservative treatment her knee pain continued.

At the MEB exam, the CI reported persistent left anterior knee pain that was increased with activities including climbing ladders, kneeling, squatting, or running. Notes in the STR indicated the CI wore a patellar brace. The MEB physical exam noted an antalgic gait favoring the left side. Examination of the left knee showed no swelling, or effusion. There was a positive patellar apprehension sign, tenderness to palpation and compression of the patella, and crepitus. The patella deviated laterally with knee extension. There was no evidence of joint line tenderness, instability, or meniscal injury. Range-of-motion (ROM) was 0 degrees to 135 degrees.

At the VA Compensation and Pension (C&P) exam approximately a month after separation, the CI reported left knee pain with running, walking, or standing for long periods of time. On examination the CI had a normal gait and posture. The examiner noted the CI was wearing a left knee brace and the left knee was not examined. The VA rating decision (VARD) dated 6 June 2003 suggested that another exam would be scheduled to evaluate the knee, but no additional C&P exam in the records addresses the left knee. The examination otherwise indicated normal motor strength and reflexes of both lower extremities.

The Board directs attention to its rating recommendation based on the above evidence. The PEB rated the chronic left knee pain condition as 5299-5003 (analogous to degenerative arthritis at 10%. The VA rated as 5257 (knee impairment) at 0% due to the inability to examine the knee because of the brace. The Board in its deliberation considered that the left knee pain persisted despite surgical and conservative treatment. The Board agreed that this met the 10% rating IAW §4.71a and there was no path to a higher rating. 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 chronic 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. 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 left knee 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
Chronic Left Anterior Knee Pain Condition
 5299-5003 10%
COMBINED
 10%


The following documentary evidence was considered:

Exhibit A. DD Form 294, dated 20120709, w/atchs
Exhibit B. Service Treatment Record
Exhibit C. Department of Veterans’ Affairs Treatment Record





         xx
         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 15 Jul 13

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


                                                      xx
                                                     Assistant General Counsel
                                                      (Manpower & Reserve Affairs)

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