RECORD OF PROCEEDINGS PHYSICAL DISABILITY BOARD OF REVIEW

NAM E: XXXXXXXXXXXXXXXXXXXXXXX BRANCH OF SERVICE: M ARINECORPS

CASE: PD-2016-01077 SEPARATION DATE: 200409 1 5

SUMMARY OF CASE: Data ext ract ed from the available evidence of record reflects tha t th is covered individual (Cl) was an active dut y E4, Ground Com municatio ns Organizatio nal Repairer, medicall y separat ed for "left knee chronic pat ellar ten donitis" with a disability rati ng of 10%.

Cl CONTENTION: " Review all con di tio ns."  The complete submission is at Exhi bit A.

SCOPE OF REVIEW: The panel' s scope of review is defined in DoDI 6040.44. It is lim ited to review of disability ratings assigned to those condit ions determined by the Physica l Evaluat io n Board (PEB) to be unfi tt ing for continued milit ary service and when specifically request ed by the Cl, those conditio ns identified by the PEB, but determined to be not unfitting or non-compensable. Any conditions outsi de the panel's defined scope of review and any content ion not request ed in th is application may remain eligible for fut ure consideration by the Board fo r Cor rec t ion of M ilit ary Records . Furt hermore, the panel' s authority is lim ited to assessing t he fairness and accuracy of PEB rating determinations and reco mme nding correct ions, where appropriat e. The panel's assessment of the PEB rating determination is based on review of medical reco rds and all available evidence for application of the Veterans Affa irs Schedule for Rating Disabilities (VASRD) standards to the unfi t t ing medica l condition (s) at t he time of separation. The panel has neither the role nor the aut hority to compensat e for post-separation progression or comp lications of service-connected conditions. That role and autho ri ty is granted by Congr ess to the Depart m ent of Veterans Aff airs, operating under a diff erent set of laws. The panel gives consideratio n to VA evide nce, part icularly with in 12 mont hs of separation, but only to the ext ent that it reaso nably reflects the severity of the disabilit y at the t ime of separatio n.

RATINGCOM PARISON:

SERVICE PEB • 200407 15	VAR D • 2004 1115	
Conditio n	Code	Rati n£	Condition	Code	Ratin£	Exam	
Left Knee Chronic Pat ellar Tendoni t is Surgically
Trea ted	
5099 -5003	
10 %	

Residual Post -Operati ve Left Knee	

5299 -5 260	

1 0%	

200 40813	
Left Knee Syst e matic (sic)
Ti bial Tub ercle Status Post Exostectom y	
Cat II					
No Placement	Residual Scar Left Knee	780 5	0%	200 40813	
COM BINEDRATING: 10%	COM BINED RATING OF ALLVA CONDITIONS: 20%	

ANALYSISSUMMARY:

Left Knee Chr onic Patellar Tendonit is Surgica lly Treated. According to service t reatment records and Medical Ev aluation Board (MEB) nar rative summary (NARSUM), the Cl' s knee condition was initia ll y not ed with running, prolonged standi ng and walking activit ies. No trau ma or inj ury was repor t ed. At the 28 October 2003 ort hopedic evaluat ion te nderness ove r the patell ar tendon and the t ibial tu bercle was noted. Radi ographic (x-ray) studies demonstrated a hypert rophic bone formation over the tibial tube rcle. At the December 2003 follow up app ointment, the Cl

continue to complain of pain localized to the tibial tubercle on the left side. On 23 February 2004, the CI underwent a left knee debridement of his patellar tendon and removal of a portion of the tibial tubercle. Post-surgery, the CI’s incision healed however, pain remained localized to the tibial tubercle under the patellar tendon, along with the feeling of instability.

The 8 June 2004 MEB NARSUM examination, 3 months prior to separation, noted complaints of instability due to continued left knee pain which prevented the CI from running. Physical examination showed a well healed surgical incision with distal neurovascular sensation and motor strength intact. No effusion was noted. Both knees were stable with varus and valgus stress, and there was no evidence of instability (negative Lachman’s, and anterior/posterior drawer testing). Knee range of motion (ROM) was flexion of 135 degrees (normal 140).

At the 13 August 2004 VA Compensation and Pension (C&P) evaluation, 1 month before separation, the CI reported his symptoms had not improved despite his surgery making it difficult for him to ambulate, kneel and engage in any kind of impact exercise. Physical examination showed a well healed scar. Gait was noted as a “stiff-legged on the left leg… more prominent when walking on heels and toes”. There was no disfigurement, tenderness, ulceration, adherence, instability, tissue loss, keloid formation or limitation of motion. The CI was not able to hop on his left leg due to pain and squatting was minimal due to pain. Motor, sensory and reflexes were normal. Knee ROM was flexion of 110 degrees and extension to 0 degrees (normal 0). Left knee ROM was limited by pain, but not by fatigue, weakness, lack of endurance or incoordination. Radiographic (x-rays) studies of the knees were normal.

The panel directed attention to its rating recommendation based on the above evidence. The PEB rated the left knee condition 10%, coded 5299-5003 (analogous to arthritis, degenerative). The Navy PEB also listed “left knee systomatic (sic) tibial tubercle status post exostectomy” condition as a related diagnosis (Category II) contributing to the disability in this case. The VA rated the left knee post-surgical condition 10%, coded 5299-5260 (analogous to leg, limitation of flexion) based on the C&P examination 1 month before separation, citing limited flexion at 110 degrees.

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 10% rating (based on §4.59, §4.40 and §4.45). There was no history or evidence of dislocated meniscus or loose body causing frequent locking with recurrent effusions (5258). 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 therefore no VASRD §4.71a route to a rating higher than the 10% adjudicated by the PEB under any applicable code. The Category II diagnosis was not a separate condition which could be reasonably justified as separately unfitting; nor would a separate rating be achievable without violation of VASRD §4.14 (avoidance of pyramiding). Therefore no additional rating is recommended. After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the panel concluded there was insufficient cause to recommend a change in the PEB adjudication for the left knee condition.

BOARD FINDINGS: In the matter of the left knee condition and IAW VASRD §4.71a, the panel unanimously or majority recommends no change in the PEB adjudication. There were no other conditions within the panel’s scope of review for consideration. The panel, therefore, recommends there be no modification or re-characterization of the CI’s disability and separation determination.

DEPARTMENT OF THE NAVY
SECRETARY OF TI-IE NAVY COUNCIL OF REVIEW BOARDS 720 KDINON STREET SE STE 309
WASHINGTON NAVY YARD, DC 20 37 4 - 50 2 3

1850
CORB: 003
10 Sep20

From: Director Secretary of the Navy Council of Review Boards
To:	
Subj:  PHYSCI AL DISABILITY BOARD OF REVIEW (PDBR) Ref:	(a) DoDI 6040.44
1.	Pursuant to reference (a), the PDBR reviewed your case and forwarded its recommendation to the Department of the Navy on 13 Aug 2020 for appropriate action.

2.	On 27 August 2020, the Assistant Secretary of the Navy (Manpower & Reserve Affairs) accepted the recommendation of the PDBR of no change to your characterization of separation or disability rating assigned by the Department of the Navy's Physical Evaluation Board.

3.	The Secreatry's decision on your PDBR applicationis final and is not subject to appeal or additional review by the Board for Correction of Naval Records.