RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXX	CASE:  PD-2014-01960
BRANCH OF SERVICE:  MARINE CORPS	BOARD DATE:  20140819
Separation Date:  20030831

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty PFC/E-2 (3051/Motor Vehicle Operator) medically separated for a left knee-tibia condition.  The 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 referred for a Medical Evaluation Board (MEB).  The left knee condition, characterized as “Osgood-Schlatter's Disease with tibial tuberosity bone fracture,” was forwarded to the Physical Evaluation Board (PEB) IAW SECNAVINST 1850.4E.  No other conditions were identified by the MEB.  The Informal PEB adjudicated “Osgood-Schlatter's Disease with tibial tuberosity bone fracture” as unfitting, rated 10%.  The CI made no appeals and was medically separated.

CI CONTENTION:  “I was rated at 10% at discharge, increased to 20% in 2012, 50% of which was …recoupment? … I believe the rating altogether was low to begin with due to the …my injury prevents me from obtaining jobs that require lots of standing. C/constantly long term ???  I also have a pending VA claim for PTSD/Anxiety. It has been pending since 10/13. I was originally diagnosed with PTSD in 2003?, again and treated in 2007 at OKC VA Reg Med Center and with  th Generalised Anxiety in 2011 in Las Vegas.  I am currently in treatment and awaiting a decision.  This condition has been very rough on my life.”

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 rating for the unfitting Osgood-Schlatter's Disease with tibial tuberosity bone fracture condition is addressed below; and, no additional conditions are within the DoDI 6040.44 defined purview of the Board.  The contended posttraumatic stress disorder (PTSD) and anxiety conditions were not identified by the MEB or PEB; and, thus are no within the Board’s purview.  These and 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 IPEB – Dated 20030423	VA* - (~5 Yrs. Post-Separation)  	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Osgood-Schlatter's Disease with Tibial Tuberosity Fracture	5299-5003	10%	S/P Operative Left Osgood-Schlatter's Disease 	5299-5260	10%	20080716	
Other x 0 (Not in Scope)	Other x 2 (Not in Scope)	
Combined:  10%	Combined:  10%	
*Derived from VA Rating Decision (VARD) dated 20080729 (most proximate to date of separation (DOS))

ANALYSIS SUMMARY:  The Board makes note that some of the CI’s contended conditions are derived from VA evaluations performed well after separation and that his current VA ratings are higher than those reflected in the above rating chart.  Although some of these conditions and ratings were assigned an effective date to the time of separation, the earliest VA rating examination underpinning them was performed 5 years after separation.  The Board’s operative instruction, DoDI 6040.44, specifies a 12-month interval for special consideration to VA findings.  This does not mean that the later VA evidence was disregarded, but the Board’s recommendations are directed to the severity and fitness implications of conditions at the time of separation.  In this circumstance, therefore, the evidence from the service record is assigned significantly more probative value as a basis for the Board’s recommendations.

Osgood-Schlatter's Disease with Tibial Tuberosity Bone Fracture Condition.  The CI developed left knee pain after a fast rope training exercise where he was fast roping out of a helicopter.  He completed his duties and was seen at the battalion aid station for conservative treatment with light duty, non-steroidal anti-inflammatory drugs (NSAIDs), rest, ice, compression and elevation.  The CI went back to the battalion aid station because there was no improvement in his left knee pain.  A left knee X-ray showed a left tibial tuberosity chip fracture proximally and vertically displaced.  A bone scan confirmed the results of the knee X-ray.  The orthopedist placed the CI on an 8-month LIMDU on 14 August 2002 for left knee tibial tuberosity fracture with limitations specific to the injury.  He underwent an osteotomy of the tibial tubercle on 3 December 2002.  Post-operatively the CI wore a knee brace and underwent extensive physical therapy (PT), however, as of 6 March 2003, there was no improvement and pain continued.  The CI was unable to perform a PFT or perform his MOS duties.  The MEB narrative summary exam (approximately 4 months prior to separation) documented that the CI had considerable left knee pain with ambulation, some slight morning stiffness and performance of anything that involved standing.  He also complained of left-sided lower extremity weakness because of the left knee.  The physical exam findings were normal gait, normal muscle strength and normal reflexes.  No range-of-motion (ROM) exam was performed.  The examiner opined that it was unlikely that the CI would recover fully from his tibial tuberosity fracture and would most likely have ongoing pain for the rest of his life, even with further PT.  The condition caused functional limitations in continuous standing, an inability to perform his MOS duties, and an inability to play in sporting events and athletic extracurricular activities such as basketball, football and baseball.  The examiner recommended that the CI continue his PT and home PT treatment regimen, additional strengthening and stretching exercises along with NSAIDs medication for control of inflammation and pain.  A left knee X-ray for chronic left knee pain was normal.  The CI followed up with primary care and was found to have continued left knee pain with tenderness over the patellar ligament and tibial tuberosity and mild to moderate patellar crepitus.

The VA Compensation and Pension exam, approximately 5 years after separation; documented that the CI reported left knee weakness, stiffness, swelling, heat, giving way, lack of endurance, locking and fatigability.  The pain was localized, sticking, crushing, sharp pain occurred four times per day and lasted for 2 hours and was rated at 8/10.  The pain was made worse by physical activity and relieved by rest, ice and NSAIDs.  The CI had functional limitations of an inability to run, jump, squat, sit, kneel or climb stairs.  The physical exam findings were a normal gait, normal leg length; however, there was left knee weakness, tenderness and crepitus.  The joint function was additionally limited by pain, fatigue, weakness, lack of endurance and pan after repetitive use with pain as the major functional impact.  All ligaments along with menisci were normal with respect to stability.  The ROM testing for left knee flexion was 130 degrees (normal 140) with pain at 120 and extension 0 (normal 0 degrees) with pain that occurred at 5/10.

The Board directs attention to its rating recommendation based on the above evidence.  The PEB coded the Osgood-Schlatter's Disease with tibial tuberosity bone fracture condition as 5299 analogous to 5003 (arthritis, degenerative [hypertrophic or osteoarthritis]) rated at 10%.  The VA coded the status post Operative Left Osgood-Schlatter's Disease condition as 5299 analogous to 5260 (leg, limitation of flexion of) rated at 10% - flexion limited to 45 degrees.  No exam indicated limited ROM to a compensable level without application of §4.59 (painful motion).  VASRD §4.71a specifies for 5003 that “satisfactory evidence of painful motion” constitutes limitations of motion and specifies  application of a 10% rating “for each such major joint or group of minor joints affected by limitation of motion.”  The left knee condition could not be reasonably rated higher than 10% using any exam proximate to separation or any alternate coding schema.  While the VA exam is approximately 5 years remote from separation, outside our 12-month window, the evidence documented the CI’s left knee condition showed no improvement with normal ROM and painful motion.  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 Osgood-Schlatter's Disease with tibial tuberosity bone fracture 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.  In the matter of the Osgood-Schlatter's Disease with tibial tuberosity bone fracture 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 20140415, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans’ Affairs Treatment Record

			
XXXXXXXXXXXXXX
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 22 Apr 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 USN
- XXXXXXXXXXXXXXX, former USMC
- XXXXXXXXXXXXXXX, former USN
- XXXXXXXXXXXXXXX, former USMC
- XXXXXXXXXXXXXXX, former USN
- XXXXXXXXXXXXXXX, former USN
- XXXXXXXXXXXXXXX, former USMC
- XXXXXXXXXXXXXXX, former USN
- XXXXXXXXXXXXXXX, former USMC
- XXXXXXXXXXXXXXX, former USN

						  XXXXXXXXXXXXXXX
	     				  Assistant General Counsel
						  (Manpower & Reserve Affairs)