RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXXX	CASE:  PD-2014-01172
BRANCH OF SERVICE:  MARINE CORPS	BOARD DATE:  20150602
SEPARATION DATE:  20090830

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E-3 (Automotive Organization Mechanic) medically separated for left knee patellar tendonitis.  The 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 light duty and referred for a Medical Evaluation Board (MEB).  The patellar tendonitis and pain in joint involving lower leg conditions were forwarded to the Physical Evaluation Board (PEB) IAW SECNAVINST 1850.4E.  No other conditions were submitted by the MEB.  The Informal PEB (IPEB) adjudicated left knee patellar tendonitis as unfitting rated 10% citing criteria of the Veterans Affairs Schedule for Rating Disabilities (VASRD).  The PEB noted that the condition did exist prior to service but they did not deduct from the 10% rating for this factor.  The remaining condition was determined to be a related Category II diagnosis (contributing to unfit).  The CI made no appeals and was medically separated.

CI CONTENTION:  “Reasons why Rating should be changed are as follows:  a lot of the time I am in an extreme amount of pain, the pain prevents me from sleeping multiple nights in succession.  My Injury limits me greatly when attempting to find a Job.  My Injury Greatly affects my sex life in a negative way.  I have difficulties performing menial tasks such as walking, standing, kneeling, crouching, bending, twisting, turning and sitting still for any extended period of time.”

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 when specifically requested by the CI, those conditions identified by the PEB, but determined to be not unfitting.  Any conditions outside the Board’s defined scope of review and any contention not requested in this application may remain eligible for future consideration by the Board for Correction of Military/Naval Records.  Furthermore, the Board’s authority is limited to assessing the fairness and accuracy of PEB rating determinations and recommending corrections, where appropriate.  The Board’s assessment of the PEB rating determinations is confined to review of medical records and all available evidence for application of the VASRD standards to the unfitting medical condition at the time of separation.  The Board has neither the role nor the authority to compensate for post-separation progression or complications of service-connected conditions.  That role and authority is granted by Congress to the Department of Veterans Affairs, operating under a different set of laws.  The Board gives consideration to VA evidence, particularly within 12 months of separation, but only to the extent that it reasonably reflects the severity of the disability at the time of separation.

RATING COMPARISON:

Service IPEB – Dated 20090608	VA - (No show for C&P Exam)  	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Left Knee Patellar Tendonitis	5099-5003	10%	Left Knee Tendonitis	5024	NSC	NO SHOW	
Chronic Left Knee Pain	CAT II					
Other x 0 (Not In Scope)	Other x 2	
Combined:  10%	Combined:  	
Derived from VA Rating Decision (VARD) dated 20100607 (most proximate to date of separation [DOS]).
*CI was a no show for the C&P exam for 20091209 – On 20120720 CI was rated 0% for Left Knee Tendonitis

ANALYSIS SUMMARY:

Left Knee Patellar Tendonitis and Subsumed Category II Condition.  The service treatment record documents that the CI had a history of bilateral knee pain prior to service.  The chronic knee pain was exacerbated by military training.  The 7 April 2008 bilateral knee X-rays showed bilateral small joint effusions (fluid collections).  The 28 April 2008 left knee magnetic resonance imaging showed patella tendonitis (tendon inflammation) and medial meniscus degeneration.  The 30 July 2008 medical evaluation documented “PT complains of pain below L knee cap.  No radiation, no popping, no locking.  Pt states there is pain c [with] walking, running, jogging, and applying pressure.  Pt states L knee gives out when walking.”  Left knee exam revealed tenderness superior to the left tibial tuberosity on the patella tendon.  There was no edema, deformities, effusion, or ecchymosis (bruising).  Valgus/varus stress (assess medial/lateral collateral ligaments), McMurray (assess menisci), Ober's (assess iliotibial bands), and Noble’s (assess iliotibial bands) tests were negative.  Range-of-motion (ROM) was 0-135 degrees.  Strength (5/5) was normal and sensation was intact.  The assessment listed patellar tendonitis.  The 30 July 2008 bilateral knee X-rays were unremarkable.  The 8 October 2008 orthopedic surgery evaluation documented “Patient voices he has had knee pains since military service, mainly snowboarding overuse injuries, developed pains in sophomore year of HS, entered military service had pains but completed basic training without set back, entered Marine Corps training (MCT) and knee pains became severe treated with therapy/sports medicine with no relief, majority of time on light duty, he was sent to MOS school, continued to have pain again sent to therapy and ortho, found to have severe patellar tendonitis, continues to have pains, consideration was given for possible debridement pt declined, now in 29 palms continues have anterior knee pain with minimal activities, unable to run, denies locking, voices giving out of the knee.”  Left knee exam revealed tibial tuberosity, patella tendon, and patella tenderness.  There was no joint line tenderness and patellar grind test (assesses abnormal patellar movement and painful crepitation) was negative.  There was no effusion, erythema (redness), or ecchymosis.  Valgus/varus stress, McMurray, Lachman's (assesses anterior cruciate ligament), and drawer (assess anterior and posterior cruciate ligaments) tests were negative.  Left knee ROM was 0-135 degrees.  The distal lower extremity was neurovascularly intact.  The assessment listed patellar tendonitis.  The narrative summary, 10 months prior to separation, recounted the history and interventions to date.  It documented “he continues to have anterior knee pain with minimal activities.  He is unable to run.  He denies locking.  He does voice occasional giving out of the knee.”  The physical exam showed a gait with a mild limp favoring his left lower extremity.  Left knee exam revealed tibial tuberosity, patella tendon, and patella tenderness.  There was no joint line tenderness and patellar grind test was positive.  There was no effusion, erythema, or ecchymosis.  There was no ligamentous laxity by drawer, Lachman, McMurray, or valgus/varus stress tests.  Left knee ROM was 0-130 degrees.  The 9 December 2008 medical board exam recorded the CI had chronic left knee pain since December 2007 which had not responded to light duty, medications, or physical therapy.  The left knee exam revealed tibial tuberosity and anterior patellar tendon tenderness.  There was no joint line tenderness.  The left knee appeared normal without effusion, ecchymosis, or erthythema.  Noble’s, Ober’s, drawer, Lachman, McMurray, and valgus/varus stress tests were negative.  Left knee ROM was 0-135 degrees.  Strength (5/5), reflexes (2+), and sensation were normal.  The general medical compensation and pension (C&P) exam, seven months after separation, reported the CI complained of 4/10 bilateral knee pain with prolonged walking or running.  The examiner deferred the musculoskeletal exam to the orthopedic C&P exam scheduled for 8 April 2010.

The Board directed attention to its rating recommendation based on the above evidence.  The IPEB, 3 months prior to separation, rated the left knee condition at 10% (VA code 5099-5003; rating by analogy, degenerative arthritis).  The PEB listed the condition as “existed prior to service [EPTS]” and reduced the rating by 0%.  The Category II condition (chronic left knee pain) was considered to contribute to the unfitting knee condition.  The Board considered the Category II condition and concurred with the findings of the PEB.  The VARD, 10 months after separation, denied service-connection for left knee condition.  The VARD cited failure to report for scheduled VA C&P exams on 10 January, 8 April and 26 April 2010.  The VARD documented that there was no objective evidence that the pre-existing condition was permanently worsened by service to establish service-connection by aggravation.  The proximate exams did not demonstrate limitation of motion to support a minimum rating under VA codes for limitation of flexion or extension (5260, 5261).  There was no instability, dislocated meniscus, or removed meniscus to support minimum ratings under the respective codes (5257, 5258, 5259).  Board members agreed that there was sufficient evidence of painful motion (§4.59) prior to separation, as well objective exam findings, to support a 10% rating under 5099-5003.  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.

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.  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 20140303, 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 17 Aug 15

      In accordance with reference (a), I have reviewed the cases forwarded by reference (b), and, for the reasons provided in their forwarding memorandums, 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:

- XXXXXXXXXXXXXXX, former USMC
- XXXXXXXXXXXXXXX, former USMC
- XXXXXXXXXXXXXXX, former USN
- XXXXXXXXXXXXXXX, former USMC
- XXXXXXXXXXXXXXX, former USN