RECORD OF PROCEEDINGS 

PHYSICAL DISABILITY BOARD OF REVIEW 

                                                         BRANCH OF SERVICE:  NAVY 
SEPARATION DATE:  20080515 

 
NAME:  XXXXX 
CASE NUMBER:  PD12-00198 
BOARD DATE:  20121012 
 
 
SUMMARY  OF  CASE:    Data  extracted  from  the  available  evidence  of  record  reflects  that  this 
covered individual (CI) was an active duty CM2/E-5 (9760/Advanced Construction Mechanic), 
medically separated for left knee patellofemoral pain syndrome (PFPS).  The CI first noted knee 
pain  after  being  struck  behind  the  knee  while  “rough  housing.”    Despite  surgery,  duty 
modifications and conservative management, the CI did not improve adequately to meet the 
physical  requirements  of  his  rating  or  satisfy  physical  fitness  standards.    He  was  placed  on 
limited duty [LIMDU] and referred for a Medical Evaluation Board (MEB).  “Other affections of 
shoulder region, not elsewhere classified” was also identified and forwarded by the MEB.  The 
Physical  Evaluation  Board  (PEB)  adjudicated  the  left  knee  PFPS  conditions  as  unfitting,  rated 
10%  with  application  of  the  Veteran’s  Affairs  Schedule  for  Rating  Disabilities  (VASRD).    The 
remaining condition, renamed left shoulder impingement syndrome, was determined to be not 
unfitting and Category III.  The PEB also determined sleep apnea to be a Category III condition 
although  this  was  not  on  the  NAVMED  6100  submission.    The  CI  made  no  appeals  and  was 
medically separated with a 10% disability rating.   
 
 
CI  CONTENTION:    “Left  knee  patellofemoral  pain  syndrome—continuing  pain;  left  shoulder 
impingement syndrome—never rated.” 
 
 
SCOPE OF REVIEW:  The Board wishes to clarify that the scope of its review as defined in the 
Department of Defense Instruction (DoDI) 6040.44, Enclosure 3, paragraph 5.e.(2) is limited to 
those conditions which were determined by the PEB to be specifically unfitting for continued 
military  service;  or,  when  requested  by  the  CI,  those  condition(s)  “identified  but  not 
determined to be unfitting by the PEB.”  The ratings for unfitting conditions will be reviewed in 
all cases.  The left shoulder impingement syndrome condition as requested for consideration 
meets  the  criteria  prescribed  in  DoDI  6040.44  for  Board  purview  and  is  addressed  below  in 
addition to a review of the rating for the unfitting condition.  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:   
 

VA (4 Mos. Pre-Separation) – All Effective Date 20080516 

Service IPEB – Dated 20080123 
Condition 

*Overall rating increased to 90% effective 20090816 per 20100218 VARD; HA increased from 0 to 30%. 

Combined:  10% 

8599-8515 
0% X 3 / Not Service-Connected x 2 

Combined:  80%* 

Left Knee PFPS 
L Shoulder Impingement  
Sleep Apnea 

Code 
5257 

Rating 
10% 

Cat III 
Cat III 

↓No Additional MEB/PEB Entries↓ 

Condition 

PFPS, Left Knee 
Tendinitis, Left Shoulder  
Obstructive Sleep Apnea 
Cervical Spine Strain 
Deg Arthritis, Lumbar Spine 
Tinnitus 
GERD 
Residuals, Lipoma 
Carpal Tunnel Syndrome 

Code 

5099-5019 

5201 
6847 
5237 
5242 
6260 
7346 
7804 

Rating 
10% 
20% 
50% 
10% 
10% 
10% 
10% 
10% 
10% 

Exam 

20080130 
20080130 
20080130 
20080130 
20080130 
20080115 
20091113 
20081219 
20081219 
20080130 

Full 
Full 

130 
0 

Comment 

Positive crepitus and grind 

Painful motion 

140 
0 

Normal exam without 

painful motion 

0% 

ANALYSIS SUMMARY:   
 
Left Knee Patellofemoral Pain Syndrome Condition.  There were three range-of-motion (ROM) 
evaluations  (two  goniometric)  in evidence,  with  documentation  of  additional  ratable  criteria, 
which the Board weighed in arriving at its rating recommendation; as summarized in the chart 
below.   

 

MEB ~7 Mos. Pre-Sep 

 

VA C&P ~4 Mos. Pre-Sep 

 

VA C&P ~7 Mos. Post-Sep 

 

Left Knee ROM 

Flexion (140 Normal) 
Extension (0 Normal) 

§4.71a Rating 

10% 

10% 

 
The  CI  was  first  evaluated  in  March  2000  for  a  2-month  history  of  knee  pain  while  running 
following trauma.  Non-surgical management was insufficient to resolve the pain, although an 
MRI performed in 2001 was normal.  He was referred to a LIMDU Board which returned him to 
full  duty.    In  June  2002  he  had  arthroscopic  surgery  with  medial  plica  (redundant  synovial 
tissue)  debridement.    Although  improved,  he  continued  to  have  chronic  knee  pain.    An  MRI 
performed on 13 June 2007, 10 months prior to separation, was unremarkable other than an 
abnormal signal of the medial meniscus thought to be consistent with the prior arthroscopy.  
His treating orthopedist noted that there was no meniscal injury on review of the MRI.  It was 
determined  that  he  had  obtained  maximal  benefit  from  outpatient  therapy,  but  without 
improvement  sufficient  to  meet  full  duty  requirements.    He  was  again  placed  on  LIMDU  on 
1 November 2007 and referred to an MEB.  The narrative summary (NARSUM) by the treating 
orthopedic surgeon was performed on 13 November 2007, 6 months prior to separation.  The 
examiner  noted  that  the  CI  had  anterior  knee  pain  with  “popping  and  cracking  behind  the 
patella.”  The symptoms were worse with impact activities, but there was no locking, catching 
or instability.  The gait was normal and range-of-motion (ROM) was full.  There was positive 
patellofemoral crepitus, positive grind, and patellar tenderness, consistent with the diagnosis of 
PFPS.  There was no medial or lateral joint line tenderness and no swelling or effusion.  Tests for 
instability were negative.  X-rays were normal.  The VA Compensation and Pension (C&P) exam 
was  performed  4  months  prior  to  separation,  on  3  January  2008.    The  CI  reported  popping, 
grinding,  stiffness  and  swelling  with  pain  underneath  the  kneecap  which  was  worse  with 
walking or running as well as going up steps.  He denied locking or giving way.  A brace had not 
been beneficial and no assistive devices were in use.  He denied flare-ups.  Posture and gait 
were  normal.    On  examination,  there  was  medial  tenderness  without  swelling  or  erythema.  
There was no muscle atrophy.  Motion was painful, but not further decreased with repetition.  
There was no grinding or instability.  Imaging was normal.  The Board noted that at a second 
C&P  examination  performed  on  19  December  2008,  7  months  after  separation,  the 
examination of the knee was essentially normal and the symptoms recorded to be resolved by 
the examiner.  The Board directs attention to its rating recommendation based on the above 
evidence.  The PEB coded the left knee 5257, other impairment of knee, and rated it at 10% for 
slight impairment.  The VA also rated the knee at 10%, but coded it as analogous to bursitis.  
The Board considered other coding options and determined that none provided an advantage 
to the CI.  The knee was stable; there was no meniscal tear and no effusion.  The ROM was 
normal  on  the  PEB  exam  and  slightly  reduced  on  the  first  C&P  examination.    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.   
 
Contended PEB Conditions.  The contended condition adjudicated as not unfitting by the PEB 
was left shoulder impingement.  The Board’s first charge with respect to this condition is an 

   2                                                           PD12-00198 

 

assessment of the appropriateness of the PEB’s fitness adjudications.  The Board’s threshold for 
countering fitness determinations is higher than the VASRD §4.3 (reasonable doubt) standard 
used  for  its  rating  recommendations,  but  remains  adherent  to  the  DoDI  6040.44  “fair  and 
equitable” standard.  The left shoulder was listed as the second condition on the second LIMDU 
period.  However, the commander specifically stated “Without full use of his lower extremities, 
he cannot be assigned to….”  There was no mention of the left shoulder.  The MEB examiner, an 
orthopedic surgeon, noted that the CI had a one year history of intermittent left shoulder pain 
without antecedent trauma.  The record shows, though, that the CI had first been seen for the 
left shoulder in 1999, 9 years prior to separation and that there had been multiple visits for the 
shoulder between this initial visit and separation.  The CI had been managed with medications, 
physical therapy, an injection and duty restrictions.  The record did not show any evidence that 
this  chronic,  recurrent  problem  had  worsened  at  the  time  of  MEB  entry  beyond  limitations 
present for several previous years.  There was no history of instability.  MRI and arthrogram 
were significant only for supraspinatus tendinitis without evidence of a rotator cuff tear and the 
labral  cartilage  of  the  shoulder  joint  was  unremarkable.    On  examination,  both  forward 
elevation and abduction were slightly reduced 10 degrees to 170 degrees with normal internal 
rotation.  The acromioclavicular joint was tender, but the biceps tendon was not.  One sign of 
impingement was present, another absent.  Strength was normal.  At the C&P examination the 
CI reported of anterior joint pain with weakness and stiffness of the shoulder associated with 
locking.  There was no swelling or giving way.  He noted flares every few days, but did not use a 
sling  or  other  assistive  device.    He  was  unable  to  lift  heavy  objects  or  work  overhead.    On 
examination, the anterior shoulder was tender and ROM reduced in both flexion and abduction 
to less than 90 degrees at 80 and 85 (normal values 180 degrees each).  Motion was painful, but 
did not worsen with repetition.  There was no muscle atrophy.  At the second VA examination, 
7 months after separation, the CI was noted to have persistent limitations in ROM as above, but 
with  normal  strength.    There  was  no  warmth,  swelling  or  erythema  nor  tenderness  to 
palpation.  Forward flexion was mildly painful, but DeLuca criteria negative.  No muscle atrophy 
was  documented.    There  is  no  documentation  in  the  record  of  intervening  trauma  or  other 
explanation to account for the deterioration in the ROM documented between the MEB and VA 
examinations  and  the  severity  of  the  condition  reported  by  the  CI.    The  Board  noted  the 
absence of muscle atrophy on all examinations and that this is consistent with use of the left 
shoulder to a degree equivalent to the unaffected right side.  The Board noted that the MEB 
examination  was  accomplished  by  an  orthopedic  surgeon  who  had  also  been  a  treating 
physician.    The  two  C&P  examinations  were  inconsistent  with the MEB  examination  and the 
remainder of the service treatment record (STR).  The left shoulder was reviewed by the action 
officer  and  considered  by  the  Board.    There  was  no  indication  from  the  record  that  it 
significantly  interfered  with  satisfactory  duty  performance  over  several  years  leading  up  to 
separation.  After due deliberation in consideration of the preponderance of the evidence, the 
Board concluded that there was insufficient cause to recommend a change in the PEB fitness 
determination for the left shoulder condition and, therefore, no additional disability ratings can 
be recommended.   
 
 
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.  In the matter of the contended 
left  shoulder  condition,  the  Board  unanimously  recommends  no  change  from  the  PEB 
determination  as  not  unfitting.   There  were  no  other  conditions  within  the  Board’s  scope of 
review for consideration.   
 
 

   3                                                           PD12-00198 

 

RECOMMENDATION:  The Board, therefore, recommends that there be no recharacterization of 
the CI’s disability and separation determination, as follows:   
 

VASRD CODE  RATING 

5257 

COMBINED 

10% 
10% 

Left Knee Patellofemoral Pain Syndrome 

UNFITTING CONDITION 

 
 
The following documentary evidence was considered: 
 
Exhibit A.  DD Form 294, dated 20120308, w/atchs 
Exhibit B.  Service Treatment Record 
Exhibit C.  Department of Veterans’ Affairs Treatment Record 
 
 
 
 
 
 
 
 

 

           XXXX 
           President 
           Physical Disability Board of Review 

   4                                                           PD12-00198 

 

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 7 Nov 12 

 

      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: 
 
                  -    former USN  
-    former USN  
-    former USMC 
-    former USN   
-    former USMC 
-    former USMC 
-    former USMC 
-    former USN  

 

 
      
 

 
 
 

 
 
 

 
 
 

 
 
 

  
  Assistant General Counsel 
  (Manpower & Reserve Affairs) 

   5                                                           PD12-00198