RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXX	CASE:  pd-2016-00131
BRANCH OF SERVICE:  Marine corps	SEPARATION DATE:  20031015

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty, E3, Finance Technician, medically separated for patellofemoral pain syndrome, with a disability rating of 10%.  

CI CONTENTION:  “Please consider all conditions.”  The complete submission is at Exhibit A.  

SCOPE OF REVIEW:  The panel’s scope of review is defined in DoDI 6040.44.  It is limited to review of disability ratings assigned 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 or non-compensable.  Any conditions outside the panel’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 panel’s authority is limited to assessing the fairness and accuracy of PEB rating determinations and recommending corrections, where appropriate.  The panel’s assessment of the PEB rating determination is based on 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(s) at the time of separation.  The panel 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 panel 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 - 20030813	VARD - 20031105	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Patellofemoral Pain Syndrome	5299-5003	10%	Residuals, Right Knee Chondromalacia with Lateral Meniscus Tear	5099-5024	10%	20030909	
			Residuals, Right Tibia Stress Fracture	5262	0%	20030909	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  70%	

ANALYSIS SUMMARY:  

Patellofemoral Pain Syndrome.  According to the service treatment record (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s right knee pain condition started while he was running a Physical Fitness Test in March 2002.  Nuclear medicine bone scan studies showed stress injuries involving the right tibia and bilateral shin splints.  The CI was treated conservatively with activity limiting profiles, physical therapy and anti-inflammatory medications with little change in his symptoms.  Magnetic resonance imaging (MRI) in March 2003 showed an iliotibial band syndrome, a lateral collateral ligament partial tear, possible lateral meniscal tear and chondromalacia patella.  Orthopedics was consulted after the MRI results and recommended continued physical therapy.  There was no surgical indication, and conservative treatment did not result in improvement sufficient to allow unrestricted duty.  

At the 28 May 2003 MEB NARSUM, 5 months prior to separation, the CI reported right knee pain with no changes since his injury in March 2002.  Physical examination showed a normal gait, no tenderness to palpation about the knee and no signs of meniscus injury.  

During the 10 June 2003 MEB examination (recorded on DD Forms 2807-1 and 2808), 4 months prior to separation, the CI reported that he continued to have right knee pain and that it had not improved with treatment.  Physical examination noted an abnormal gait secondary to pain with walking.  The examiner noted tenderness to palpation but did not specify the location.  

At the 31 July 2003 physical therapy evaluation, 3 months prior to separation, the therapist noted flexion to 70 degrees (normal 140), extension to 0 degrees (normal) and tenderness to palpation.  

At the 9 September 2003 VA Compensation and Pension (C&P) evaluation, 1 month before separation, the CI reported constant pain and swelling with minimal activity.  Physical examination showed an antalgic gait, tenderness, crepitus and pain with motion.  Range of motion of the right knee was flexion 135 degrees (normal 140) and extension 0 degrees (normal).  Plain film x-rays of the right knee performed in conjunction with the C&P evaluation were read as normal.  

The panel directed attention to its rating recommendation based on the above evidence.  The Navy PEB rated the right knee condition 10%, coded 5299-5003 (analogous to arthritis, degenerative).  The PEB also listed the iliotibial band syndrome and pes anserinus bursitis conditions as related diagnoses (Category II) that contributed to the disability in this case.  The panel agreed that the iliotibial band syndrome and pes anserinus bursitis were diagnoses related to the overall right knee pain syndrome and were not separate conditions which could be separately rated IAW §4.14 (avoidance of pyramiding; more than one rating based on the same impairment is prohibited).  The VA rated the right knee condition 10%, coded 5099-5024 (analogous to tenosynovitis), citing decreased ROM with pain and crepitus on flexion, without fatigue, weakness, lack of endurance or incoordination.  

There was no limitation of motion which supported a rating under the diagnostic codes for limitation of flexion or extension (5260, 5261).  However, there was evidence of painful motion with functional loss supporting a minimum 10% rating (based on §4.59, §4.40 and §4.45) as adjudicated by the PEB.  There was no history of dislocated meniscus or loose body causing frequent locking with recurrent effusions (5258), or history of surgery to remove a meniscus (5259) to support a rating under the respective codes.  There was no fracture, non-union, or malunion of the femur or tibia to support consideration under the respective codes for knee impairment related to long bone conditions (5255, 5262).  There was therefore no VASRD §4.71a route to a rating higher than the 10% adjudicated by the PEB under any applicable code.  

After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the panel concluded that there was insufficient cause to recommend a change in the PEB adjudication for the right knee condition.  

BOARD FINDINGS:  In the matter of the patellofemoral pain syndrome condition and IAW VASRD §4.71a, the panel unanimously recommends no change in the PEB adjudication.  In the matter of the contended iliotibial band syndrome and pes anserinus bursitis conditions, the panel unanimously agrees that it cannot recommend them for additional disability ratings.  There are no other conditions within the panel’s scope of review for consideration.  

The panel, therefore, recommends that there be no modification or re-characterization of the CI’s disability and separation determination.  

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20160317, 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

      In accordance with reference (a), I have reviewed the cases listed below and 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:

		- XXXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXXX, former USMC
		- XXXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXXX, former USMC
		- XXXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXXX, former USMC
		- XXXXXXXXXXXXXXXXXXX, former USMC

		
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	     				  Acting