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AF | PDBR | CY2012 | PD2012 01934
Original file (PD2012 01934.rtf) Auto-classification: Denied
RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME: xx         CASE: PD1201934
BRANCH OF SERVICE: MARINE CORPS  BOARD DATE: 20130528
SEPARATION DATE: 20020930


SUMMARY OF CASE: Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty LCpl/E-3 (0311/Rifleman) medically separated due to iliotibial band syndrome (ITBS) of the left knee. In March 2001, the CI developed left knee pain after a 15 mile hike. He was treated, but his knee condition could not be adequately rehabilitated to meet the physical requirements of his Military Occupational Specialty (MOS) or satisfy physical fitness standards. He was placed on limited duty (LIMDU), and underwent a Medical Evaluation Board (MEB). The left knee condition was characterized as “chronic left knee pain status post lateral release” and “iliotibial band syndrome.” These two conditions were forwarded to the Physical Evaluation Board (PEB), IAW SECNAVINST 1850.4E. No other conditions were submitted by the MEB. The PEB found the ITBS unfitting, and rated it 10%. The other left knee condition w as adjudicated as Category II (related to and contributing to the unfitting ITBS condition ) . The CI made no appeals and was medically separated.


CI’s CONTENTION: “My condition has only got worse. I walk with a cane and my right knee is now hurting after carrying the load my left knee could not. I was recently awarded an increase in all my disabilities.”


SCOPE OF REVIEW: The Board’s scope of review as defined in DoDI 6040.44, is limited to those conditions determined by the PEB to be unfitting for 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 ITBS condition is addressed below. Chronic left knee pain status post (s/p) lateral release was adjudicated as Category II, and is also addressed. No other conditions are within the defined purview of the Board. Any conditions or contention not requested in his application, or otherwise outside the defined scope of review, may be eligible for future consideration by the Board for Correction of Naval Records.


 RATING COMPARISON :

Navy PEB – dated 20020806
 VA – (<1 mo. Pre-Separation)
Condition
 Code Rating Condition Code Rating Exam
Iliotibial Band Syndrome 5024-5003 10% Left Knee Condition 5299-5255 10% 20020906
Chronic Left Knee Pain Category II No corresponding VA entry
No Additional MEB/PEB Entries
 Other x 5 20020906
Rating: 10%
 Combined: 40%
Derived from VA Rating Decision (VA RD ) dated 200 20125 ( most proximate to date of separation )

ANALYSIS SUMMARY: The Board acknowledges the sentiment expressed by the CI regarding the impairment with which his conditions continue to burden him, and the significant 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 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.

Iliotibial Band Syndrome (ITBS). In March 2001, this Marine developed left knee pain following a 15 mile hike. He was seen by orthopedics and diagnosed with patellofemoral syndrome and a tight lateral retinaculum. In September 2001, he underwent a lateral retinacular release on the left knee. After surgery, he was treated with physical therapy and other treatment modalities. However, his knee pain persisted and an MEB was initiated. The MEB narrative summary (NARSUM) from February 2002 recommended 8 months of LIMDU. However, it was then determined that the CI would be processed for a PEB. The PEB physical examination (PE) was in April 2002. At that exam, the left knee had full range-of-motion (ROM). There was mild tenderness to palpation (TTP), but no grind. The knee was stable to varus/valgus stress. Lachmann’s and McMurray’s were both negative. As noted above, the Navy PEB found him unfit for military duty, due to ITBS.

In September 2002, the CI had a VA Compensation and Pension (C&P) exam, performed less than a month prior to separation. The CI reported a locking pain in his left knee that usually occurred in the morning. He also reported swelling in his left knee after long walks. Posture and gait were normal. PE of the left knee revealed no erythema, swelling, effusion, or warmth. There was no TTP or crepitus. Flexion was 115 degrees, with pain. The two ROM evaluations which the Board weighed in arriving at its rating recommendation are summarized below.

Left Knee ROM
 MEB ~ 5 ½ mos. Pre-Sep
(20020409)
VA C&P ~ <1 m o. Pre-Sep
(20020906)
Flexion (140 ⁰ is Normal)
 “ Full flexion ” 115 ⁰
Extension (0 ⁰ is Normal)
 “ Full extension ” 0 ⁰
Comment
 No mention of painful motion Pain with motion
§4.71a Rating
 0 % 10 % *
     *10% based on VASRD §4.40 (Functional loss), §4.45 (The joints), and §4.59 (Painful motion) invalid font number 31502

The Board carefully examined all available information, and directs attention to its rating recommendation based on the above evidence. The Navy PEB and the VA chose different coding options for the left knee condition, but both assigned a disability rating of 10%. After a thorough review of the service treatment record (STR), the Board determined that the CI’s left knee ITBS condition was essentially non-compensable based solely on the 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 found insufficient cause to recommend a change in the PEB adjudication for the ITBS condition of the left knee.

Other PEB Condition. The other PEB condition was, “Chronic left knee pain, status post lateral release.” This condition was adjudicated by the PEB as Category II (related to and contributing to the unfitting ITBS condition). The Board determined that this condition was indeed related to and contributed to the unfitting ITBS condition, and did not constitute a separately unfitting condition for disability rating purposes. Therefore, it is appropriate for this other PEB condition to be considered as Category II. After due deliberation, and consideration of all the evidence, the Board concluded that there was insufficient cause to recommend a change in the PEB adjudication of the “chronic left knee pain, status post lateral release.”


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 ITBS, and IAW VASRD §4.40, §4.45, §4.59, and §4.71a, the Board unanimously recommends no change in the PEB adjudication. In the matter of the chronic left knee pain, s/p lateral release, the Board unanimously recommends no change in the PEB adjudication as Category II.


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
Iliotibial band syndrome, of the left knee 5024-5003 10%
COMBINED
 10%


The following documentary evidence was considered:

Exhibit A. DD Form 294, dated 20120816, 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 19 Aug 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 USN
- former USMC
- former USN
- former USMC
- former USN
- former USN
- former USMC
- former USN


                                                      xx
                                                     Assistant General Counsel
                                                      (Manpower & Reserve Affairs)


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