RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2014-01363
BRANCH OF SERVICE:  Marine Corps 	SEPARATION DATE:  20071010

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E5, Electrician, medically separated for “bilateral patellar tendonitis,” with a disability rating of 0%.

CI CONTENTION:  The CI’s condition should have included other disabilities resulting in a higher rating.  The CI’s complete submission is at Exhibit A.  

SCOPE OF REVIEW:  The Board’s scope of review is defined in DoDI 6040.44.  It is limited to those conditions determined by the Physical Evaluation Board (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 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 based upon a review of medical records and all available evidence for application of the Veterans Affairs Schedule for Rating Disabilities (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 PEB - 20060922	20080110	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Bilateral Patellar Tendonitis	5024	0%	Left Patella Chondritis	5299-5260	10%	20060821	
			Right Iliotibial Band Syndrome	5299-5260	10%		
COMBINED RATING:  0%	COMBINED RATING OF ALL VA CONDITIONS:  40%	

ANALYSIS SUMMARY:  

Bilateral Patellar Tendonitis.  The narrative summary (NARSUM) noted insidious onset of bilateral knee pain without history of trauma.  A diagnosis of bilateral patellofemoral pain syndrome was given in 2004 after normal radiographic evaluations (MRI).  Despite treatment, the bilateral knee condition could not be adequately rehabilitated to meet the physical requirements of the CI’s military specialty and the CI was referred for an MEB.  The MEB forwarded “bilateral patellar tendonitis” for PEB adjudication.  

A limited duty profile dated 23 January 2006 (21 months pre-separation) addressed 2 conditions: a right knee patellar tendonitis and patellar chondromalacia, left greater than right.  Orthopedic visits in January and May (17 months pre-separation) 2006 both documented full range of motion, and no evidence of instability, laxity, or meniscal injury.  Bilateral crepitus was noted in January, while other findings of patellar disease (“grind” or pain with compression) were noted in May.  Tenderness at the insertion of the patellar tendon (consistent with Osgood-Schlatter disease) was present bilaterally and noted to be greater on the right knee than the left.  

The MEB NARSUM exam was performed on 15 June 2006 (16 months pre-separation).  The CI reported chronic bilateral anterior knee pain exacerbated by repetitive running and maneuvering stairs and denied locking and instability.  Bilateral knee examination showed tenderness of the anterior and medial knees, with a range of motion of 0-140 degrees (normal).  There was normal strength and sensation with no evidence of effusion, ligamentous instability, or meniscal injury.  

At the VA Compensation and Pension (C&P) examination performed 21 August 2006 (14 months pre-separation), the examiner documented no evidence of effusion, crepitus, or painful motion.   There was pain on palpation of the medial and lateral joint lines bilaterally.  Flexion of the right and left knees was to 97 and 95 degrees, respectively; with normal extension bilaterally.  There were no additional limitations after repetition.  Radiographs (X-rays) in August and September 2006 (13 months pre-separation) documented Osgood-Schlatter disease on the right knee and an inconsistent effusion of the left knee.  There was no other joint pathology.  

The commander’s non-medical assessment, dated 28 August 2006 (14 months pre-separation), noted that the CI would be “unable to perform his duties…due to his chronic knee complaints.”  There were no more entries in the service treatment record regarding the bilateral knee condition.  

The Board directed attention to the rating recommendation based on the above evidence.  The PEB rated 0% for the “bilateral patellar tendonitis,” coded 5024 (tenosynovitis).  The VA separately rated each knee at 10%: with the “left patellar chondritis” and the “right iliotibial band syndrome” analogously coded as 5299-5260 (leg, limitation of flexion).  In this case, both knees were profiled, considered to fail retention standards, and implicated by the NARSUM and in the commander’s statement.  Members agree therefore that each knee is reasonably justified as separately unfitting and that identical coding and disability ratings are recommended.  The Board discussion deliberated whether there was sufficient evidence of painful motion IAW VASRD §4.59 [including §4.40 (functional loss) and §4.45 (the joints)] to warrant minimal compensable ratings for the bilateral knees.  There were several entries indicting bilateral knee pain with use.  There was radiographic evidence of left knee effusion (August 2006) and evidence of intermittent crepitus (which is specified in §4.59), pain with compression, and tenderness at the patellar insertion of both knees.  The Board considered that positive patellar compression testing was painful motion as it signified pain around the kneecap when moving the knee joint.  The Board agreed that there was sufficient evidence to reasonably concede painful motion in support of a 10% rating for each knee, analogously coded 5299-5014 (osteomalacia) or 5299-5024 (tenosynovitis).  The ranges of motion in evidence do not support a higher rating under any of the flexion (5260) or extension (5261) codes.  There was no documentation of meniscal injury for rating under 5258 or 5259.  There was no documentation of recurrent subluxation or lateral instability for a higher rating under 5257 (knee, other impairment of).  There was no evidence of malunion causing moderate knee disability for a higher rating under code 5262 (tibia and fibula, impairment of).  After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the Board unanimously recommends separate disability rating of 10% each coded 5299-5024 for the bilateral knee condition.    

BOARD FINDINGS:  In the matter of the right and left patellar tendonitis conditions, the Board unanimously agrees that both knees were separately unfitting and unanimously recommends a disability rating of 10% each, coded 5299-5024 IAW VASRD §4.71a.  There were no other conditions within the Board’s scope of review for consideration.  The Board recommends that the CI’s prior determination be modified as follows, effective as of the date of the prior medical separation:  

CONDITION	VASRD CODE	PERMANENT RATING	
Right Patellar Tendonitis	5299-5024	10%	
Left Patellar Tendonitis	5299-5024	10%	
COMBINED	20%	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20140318, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

MEMORANDUM FOR COMMANDER, NAVY PERSONNEL COMMAND
	         DEPUTY COMMANDANT, MANPOWER & RESERVE AFFAIRS	
	                          
Subj:  PHYSICAL DISABILITY BOARD OF REVIEW (PDBR) RECOMMENDATIONS          

Ref:  (a) DoDI 6040.44
	(b) PDBR ltr dtd 29 Apr 16 ICO XXXXXXXXXXXXXXXXXXXX  
	(c) PDBR ltr dtd 21 Jun 16 ICO XXXXXXXXXXXXXXXXXXXX
	(d) PDBR ltr dtd 29 Apr 16 ICO XXXXXXXXXXXXXXXXXXXX 
	(e) PDBR ltr dtd 17 Jun 16 ICO XXXXXXXXXXXXXXXXXXXX
	(f) PDBR ltr dtd 27 May 16 ICO XXXXXXXXXXXXXXXXXXXX
	(g) PDBR ltr dtd 16 Jun 16 ICO XXXXXXXXXXXXXXXXXXXX

1.  Pursuant to reference (a), the recommendations of the Physical Disability Board of Review set forth in references (b) through (g) are approved.

2.  The official records of the following individuals are to be corrected to reflect the stated disposition:
     
     a. XXXXXXXXXXXXXXXXXXXX, former USN: Entitlement to disability separation pay with a 20 percent disability rating (increased from 10 percent) effective date of discharge. 

     b. XXXXXXXXXXXXXXXXXXXX, former USMC: Entitlement to disability separation pay with a 20 percent disability rating (increased from 10 percent) effective date of discharge. 

     c. XXXXXXXXXXXXXXXXXXXX, former USN: Entitlement to disability separation pay with a 20 percent disability rating (increased from 10 percent) effective date of discharge. 

     c. XXXXXXXXXXXXXXXXXXXX: Entitlement to disability separation pay with a 20 percent disability rating (increased from 0 percent) effective date of discharge. 

     d. XXXXXXXXXXXXXXXXXXXX, former USMC: Retroactive placement on the Permanent Disability Retired List with a 40 percent disability rating (increased from 20 percent) effective date of discharge. 

     e. XXXXXXXXXXXXXXXXXXXX, former USN: Entitlement to disability separation pay with a 20 percent disability rating (increased from 10 percent) effective date of discharge. 

3.  Please ensure all necessary actions are taken to implement these decisions, including the recoupment of disability severance pay, if warranted, and notification to the subject members once those actions are complete.
	 XXXXXXXXXXXXXXXXXXXX
	 Assistant General Counsel
		(Manpower & Reserve Affairs)