RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	 	CASE:  PD-2013-00654
BRANCH OF SERVICE:  NAVY		BOARD DATE:  20140506
SEPARATION DATE:  20020816

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty P02/E-5 (AK2/Aviation Storekeeper) medically separated for bilateral patellofemoral pain syndrome (PFPS), right greater than left.  In February 2000, the CI reported he felt a sudden pain in the right knee while running.  Despite conservative therapy over a 16-month period and being placed on Limited Duty (LIMDU), the condition could not be adequately rehabilitated to meet the physical requirements of his Rating or satisfy physical fitness standards.  His LIMDU was extended and he was referred for a Medical Evaluation Board (MEB).  The MEB also identified and forwarded two other conditions for PEB adjudication.  The Informal PEB dated 7 January 2002 determined the CI was fit to continue on active duty.  The CI requested reconsideration of the findings and submitted additional evidence.  The Reconsideration PEB then adjudicated the bilateral PFPS, right greater than left, as unfitting, rated 10% and 0%, respectively.  Tripartite right patella was determined to be a condition related to the unfitting diagnosis and was not separately rated.  The remaining condition was determined to be Category III (a condition that was not separately unfitting and did not contribute to the unfitting condition).  The CI conditionally accepted the findings and requested to be allowed to remain on active duty in a permanent LIMDU status through August 2002, which was granted.  He was then separated.

CI CONTENTION:  “2001- Tripler Army Medical Center was seen on two occasions.  Suggested knee replacement surgery on both (L) and (R) knees at that time.  A second opinion was sought by the same medical facility.  Again, knee replacement surgery was suggested. However, the Orthopedic surgeon recommended to wait until I was older in age and/or could no longer bare with the pain.  Very well could be the result of a double ankle sprain suffered while deployed in the Gulf onboard the USS John C. Stennis.  Both ankles twisted inward while carrying aircraft equipment down a ladderwell.  The ship took high seas which caused my injury and near head trauma.  I was issued light duty for >a week.  To date, both ankles continue to click and swell as well as both knees.  Right knee will make popping sounds when returning from a bent position. Stairs continue to be an issue as sharp debilatating pains in the patella renders me unable to function.  I am forced to return to my desk and elevate the knee.”

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 ratings for the unfitting knee condition(s) are addressed below; no additional conditions are within the Board’s defined DoDI 6040.44 purview.  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 Recon PEB – Dated 20020204	VA - (Exam ~ 5 Mos. Post-Separation)  	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Bilateral Patellofemoral Pain Syndrome, Right Greater Than Left	5299-5003	10%	Right Knee Injury	5257	10%	20030110	
	5299-5003	0%	Left Knee Injury	5257	NSC*	20030110	
Tripartite Right Patella	Related to Unfit Condition	Other x 6	20030110	
No Additional MEB/PEB Entries in Scope			
Combined:  10%	Combined:  10%	
Derived from VA Rating Decision (VARD) dated 20030322 (most proximate to date of separation [DOS]).
* Not Service-Connected (NSC)

ANALYSIS SUMMARY:  The Board acknowledges the impairment with which the CI’s service-connected condition continues to burden him but notes that the Disability Evaluation System has neither the role nor the authority to compensate members for anticipated future severity or potential complications of conditions resulting in medical separation.  That role and authority is granted by Congress to the Department of Veterans Affairs, operating under a different set of laws.

Bilateral Patellofemoral Pain Syndrome (PFPS).  Service treatment records evidence that the CI first presented for bilateral knee pain in March 2000.  At that time he reported pain with running.  The physical examination was significant for bilateral knee tenderness to palpation at the outside, lower edge of the patella and full active range-of-motion (ROM).  A patella grind was noted in the right knee (a test to produce pain in the knee cap that can indicate PFPS).  The CI was diagnosed with probable early PFPS and was treated conservatively with anti-inflammatory medications, activity modification and physical therapy.  Radiographic evaluation of the knees on 22 August 2000 was normal except for a tripartite patella (a normal variation in the anatomy of the patella).  A bone scan performed on 3 October 2000 demonstrated stress changes of the right greater than left patella and mild stress changes in the tibial tuberosity (bony protrusion below the knee), left greater than right.  A magnetic resonance image of the right knee performed 22 December 2000 suggested that there was abnormal motion of the right patella with resultant pain.  The MEB evaluation performed on 14 September 2001 evidenced use of a right knee brace.  The physical examination documented full ROM of the right knee with discomfort and tenderness at the right patella and surrounding area.  The narrative summary dated 20 September 2001 evidenced persistent bilateral knee pain despite conservative management and an orthopedic determination that the CI was not a surgical candidate.  The knee examination demonstrated significant tenderness to palpation at the inside of the right knee, right patellar area and with pressure applied to the patella.  Bilateral knee ROM was noted as approximately 0-130 degrees.  At the VA Compensation and Pension examination performed 5 months after separation, the CI reported right greater than left knee pain and weakness.  He denied stiffness, swelling, locking and instability.  He reported that his employment required a lot of walking and produced mild to moderate pain; which was relieved by rest.  He reported use of anti-inflammatory medication as needed and a right knee brace.  The knee examinations demonstrated no evidence of painful motion, edema or effusion, instability, weakness, tenderness, redness, heat, or abnormal movement or guarding of movement.  The knee ROM was noted as: right knee: 0-135 degrees (5 degrees less than normal), left knee: 0-140 degrees, extension: 0 degree bilaterally.

The Board directs attention to its rating recommendation based on the above evidence.  The PEB adjudicated the bilateral PFPS, right greater than left, condition as unfitting rated at 10% (right) and 0% (left) respectively, coded 5299-5003.  The VA did not service-connect the left knee and awarded a 10% disability rating for right knee, coded 5257 (right knee injury).  The Board noted that there were multiple treatment entries documenting right greater than left knee pain, evidenced by right knee pathology on radiograph and use of a brace for the right knee.  The Board noted that the absence of radiographic evidence of left knee pathology and absence of evidenced left knee pain on both the MEB and VA examinations.  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 bilateral PFPS 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 bilateral PFPS, right greater than left, 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 re-characterization of the CI’s disability and separation determination.

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20130525, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans’ Affairs Treatment Record

				

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 Dec 14

      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:

- XXXXXXXXXXXXXX, former USN    
- XXXXXXXXXXXXXX, former USMC  
- XXXXXXXXXXXXXX, former USMC
- XXXXXXXXXXXXXX, former USN
- XXXXXXXXXXXXXX, former USMC