RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2016-00213
BRANCH OF SERVICE:  Marine Corps	SEPARATION DATE:  20071031

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E3, Basic Marine, medically separated for “left knee plica syndrome,” with a disability rating of 0%.

CI CONTENTION:  “Misdiagnosed by treating physician.  Was diagnosed with Plica Syndrome.  Probably actually is Patella Femoral Syndrome.”  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 - 20070920	VARD - 20080801	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Left Knee Plica Syndrome	5099-5003	0%	Left Knee Plica Syndrome	5260	10%	20080519	
COMBINED RATING:  0%	COMBINED RATING OF ALL VA CONDITIONS:  10%	

ANALYSIS SUMMARY:

Left Knee Plica Syndrome.  According to the service treatment record (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s left knee pain condition began in April 2007 during basic training.  There was no benefit to rest, physical therapy or a steroid injection.  On 07 June 2007, 5 months before separation, the CI underwent left knee arthroscopy and arthroscopic plica debridement, a synovectomy and chondroplasty.  Continued therapy did not provide improvement to allow the CI to pass a PT test to complete Basic Training.  

At the 31 May 2007 left knee magnetic resonance imaging (MRI) study of the left knee, the radiologist noted a subchondral cyst in the medial tibial plateau (radiographic evidence of arthritis).  During a 29 June 2007 orthopedic evaluation, 3 weeks after surgery and 4 months before separation, the CI reported left knee pain and stiffness.  Physical examination revealed the use of a cane.  There was effusion and tenderness to palpation.  Range of motion (ROM) was flexion 120 degrees (normal 140) and extension 0 degrees (normal); painful motion was not addressed.  Two follow-on orthopedic evaluations, performed 3 months and 1 month before separation, revealed full ROM of flexion 140 degrees (normal) and extension 0 degrees (normal); painful motion was not addressed.  

The 24 August 2007 MEB NARSUM examination, 2 months prior to separation, noted complaints of the persistent inability to run secondary to anterior knee pain [left], which she localized to the medial side, and the most she could run at that time, 3 months postoperatively, was one-quarter of a mile.  She denied any mechanical symptoms.  Quadriceps tone and strength was within normal limits.  Physical examination showed left knee patellar facet tenderness.  ROM was flexion 140 degrees (normal) and extension 0 degrees (normal); painful motion was not addressed.  During the 24 August 2007 MEB examination (recorded on DD Forms 2807-1 and 2808), 2 months prior to separation, physical examination showed painful motion of the left knee.  (p. 38)

At the 19 May 2008 VA Compensation and Pension (C&P) evaluation, performed 7 months after  separation, the CI reported daily knee pain aggravated by standing and occasionally used a cane with flare ups during cold and rainy weather.  Physical examination showed a normal gait without effusion and negative meniscus testing.  Repetitive ROM was flexion at 145 degrees (normal 140) with popping and extension 0 degrees (normal) painful motion was not present.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the left knee plica syndrome 0%, coded 5099-5003 (analogous to degenerative arthritis).  The Navy PEB also listed “Surgical Treatment of above” as a related Category II condition (a condition that contributed to the primary unfitting condition but was not separately ratable).  The impairment from the surgical treatment was properly subsumed under the overall rating for the left knee plica syndrome IAW §4.14 (avoidance of pyramiding; more than one rating based on the same impairment is prohibited).  The VA rated the left knee plica syndrome condition 10% coded 5260 (leg, limitation of flexion), based on the C&P evaluation 7 months after separation, citing painful motion.  

The panel agreed there was no limitation of motion which supported a rating under the diagnostic codes for limitation of flexion or extension (5260, 5261).  There was no fracture, nonunion, 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 evidence of painful motion with functional loss supporting a minimum 10% rating (based on §4.59, §4.40 and §4.45).  There was also a finding of a left knee subchondral cyst (evidence of arthritis).  The description under VASRD code 5003 states ”When however, the limitation of motion of the specific joint or joints involved is noncompensable under the appropriate diagnostic codes, a rating of 10% is for application for each such major joint.”  VASRD §4.14 (avoidance of pyramiding; more than one rating based on the same impairment is prohibited) does not allow combining ratings.  

After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the panel recommends a disability rating of 10% for the left knee plica syndrome condition, coded 5099-5003.  

BOARD FINDINGS:  In the matter of the left knee plica syndrome condition, the panel unanimously recommends a disability rating of 10%, coded 5099-5003 IAW VASRD §4.71a.  There are no other conditions within the panel’s scope of review for consideration.  

The panel 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	
Left Knee Plica Syndrome	5099-5003	10%	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20160412, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

MEMORANDUM FOR DEPUTY COMMANDANT (Manpower and Reserve Affairs)
		   COMMANDER, NAVY PERSONNEL COMMAND	
	                          
Subj:  PHYSICAL DISABILITY BOARD OF REVIEW (PDBR) RECOMMENDATIONS          

Ref:  (a) DoDI 6040.44
	(b) PDBR ltr dtd 28 Sep 17 ICO XXXXXXXXXXXXXXXXXX, former USN
	(c) PDBR ltr dtd 17 Oct 16 ICO XXXXXXXXXXXXXXXXXX, former USMC 
	(d) PDBR ltr dtd 20 Sep 17 ICO XXXXXXXXXXXXXXXXXX, former USMC
	(e) PDBR ltr dtd 28 Sep 17 ICO XXXXXXXXXXXXXXXXXX, former USN
	(f) PDBR ltr dtd 20 Sep 17 ICO XXXXXXXXXXXXXXXXXX, former USMC
	(g) PDBR ltr dtd 20 Sep 17 ICO XXXXXXXXXXXXXXXXXX, former USMC
	(h) PDBR ltr dtd 15 Jun 17 ICO XXXXXXXXXXXXXXXXXX., former USN
	(i) PDBR ltr dtd 20 Sep 17 ICO XXXXXXXXXXXXXXXXXX, former USN
	(j) PDBR ltr dtd 5 Sep 17 ICO XXXXXXXXXXXXXXXXXX, former USMC 

1.  Pursuant to reference (a), the recommendations of the Physical Disability Board of Review set forth in references (b) through (j) are approved.  The official records of the following individuals are to be corrected as follows:

     a. XXXXXXXXXXXXXXXXXX, former USN: Entitlement to disability separation pay with a 20 percent disability rating (increased from 0 percent) effective date of discharge. 

     b. XXXXXXXXXXXXXXXXXX, former USMC: Placement on the Permanent Disability Retired List with a 30 percent rating (increased from 20 percent) effective date of discharge.

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

     d. XXXXXXXXXXXXXXXXXX, former USN: Placement on the Permanent Disability Retired List with a 40 percent rating (increased from 20 percent) effective date of discharge.

     e. XXXXXXXXXXXXXXXXXX, former USMC: Entitlement to disability separation pay with a 10 percent disability rating (increased from 0 percent) effective date of discharge. 

     f. XXXXXXXXXXXXXXXXXX, former USMC: Placement on the Permanent Disability Retired List with a 30 percent rating (increased from 20 percent) effective date of discharge.

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

Subj:  PHYSICAL DISABILITY BOARD OF REVIEW (PDBR) RECOMMENDATIONS 

     h. XXXXXXXXXXXXXXXXXX, former USN: Placement on the Permanent Disability Retired List with a 30 percent rating (increased from 10 percent) effective date of discharge.

     i. XXXXXXXXXXXXXXXXXX, former USMC: Entitlement to disability separation pay with a 10 percent disability rating (increased from 0 percent) effective date of discharge. 
     
3.  Please take action to implement these decisions and provide notification to the above individuals once those actions are complete.

	XXXXXXXXXXXXXXXXXX
	Acting