RECORD OF PROCEEDINGS PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXX		CASE: PD-2017-00769 BRANCH OF SERVICE: MARINE CORPS	SEPARATION DATE: 20081129

SUMMARY OF CASE: Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E4, Machine Gunner, medically separated for right-sided “patellofemoral syndrome” and “tendonitis bicipital,” rated 10% each, with a combined disability rating of 20%.

CI CONTENTION:  Review of all conditions requested. 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 Medical Evaluation Board (MEB), but determined by the PEB 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. The panel’s authority is limited to assessing the fairness and accuracy of PEB rating determinations and recommending corrections when appropriate. The panel’s assessment of the PEB rating determination is based on review of medical records and all available evidence relevant to application of the Veterans Affairs Schedule for Rating Disabilities (VASRD) standards for 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, which operates 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 disability at the time of separation.

RATING COMPARISON:

SERVICE PEB - 20080915	VARD - 20090327	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Right Patellofemoral Syndrome	5099-5003	10%	Chronic Instability and ACL Insufficiency of Left Knee…	5257	10%	20090204	
Right Tendonitis Bicipital	5024	10%	Chronic Right Shoulder Strain with Bicipital Tendonitis	5299-5260	10%	20090204	
COMBINED RATING: 20%	COMBINED RATING OF ALL VA CONDITIONS: 50%	
	
ANALYSIS SUMMARY:

Right Patellofemoral Syndrome. According to the service treatment record (STR) and MEB narrative summary (NARSUM), the CI’s right knee condition began in approximately 2005 without specific trauma or injury during pre-deployment hikes. During his first deployment pain increased and improved with rest post-deployment. During his second deployment pain returned. Treatment was conservative with nonsteroidal anti-inflammatory drugs and physical therapy (PT); however, there was no surgical indication.  X-rays of the right knee dated 10  June

2008 were normal. A 15 April 2008 MRI showed a small beaded cystic structure associated with the anterior medial knee. No meniscal tear or cruciate ligament injury was seen. Right knee pain did not subside.

During the 17 July 2008 MEB orthopedic examination, less than 5 months prior to separation, the CI reported chronic right knee pain, but denied any instability. Physical examination showed bilateral patellar tendon tenderness as well as tenderness about the medial and lateral facets of the right patella. Instability testing was negative, and there was normal motor strength in the quadriceps and hamstring tendons as well as hip abductors and adductors. He had a full range of motion (ROM) from 0-130 degrees bilaterally. There was no evidence of a meniscal tear and painful motion was not addressed. The 30 July 2008 MEB NARSUM examination, 4 months before separation, noted the complaint of right knee pain. Physical examination revealed normal bilateral lower extremity motor strength and no instability or laxity. No ROM measurements were in evidence.

During the 4 February 2009 VA Compensation and Pension (C&P) examination, 2 months after separation, the CI reported chronic-daily right knee pain, stiffness, instability, and a feeling of giving way. Physical examination showed a normal gait. Right knee extension was 0 degrees and flexion was 120 degrees, both with pain. There was no additional loss of motion with repetition and no instability or crepitus (grinding sensation).

The panel directed attention to its rating recommendation based on the above evidence. The PEB rated the right knee condition 10%, analogously coded 5099-5003 (degenerative arthritis). The Navy PEB also listed “joint pain localized to the right knee” as a related Category II condition that contributed to the primary unfitting condition but was not separately ratable. The panel considered this impairment and agreed the pain was properly subsumed under the overall rating for the right knee condition 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%, analogously coded 5299-5260 (leg, limitation of flexion), based on the C&P examination, citing painful motion.

The panel agreed there was no limitation of motion (5260, 5261) or instability (5257) to support a 10% rating; however, there was sufficient evidence of painful motion IAW VASRD §4.59 to support a 10% rating adjudicated by the PEB. There was no evidence of dislocated meniscus or loss body causing frequent locking with recurrent effusions (5258), or fracture, nonunion or malunion of the femur or tibia causing a knee impairment (5255, 5262) to support a higher rating under those codes.  After due deliberation, considering all 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 right knee condition.

Right Bicipital Tendonitis. According to the MEB NARSUM and STR, the right-hand-dominant CI’s right shoulder condition began in August 2007 while pulling a wrench when changing a truck tire. It was treated conservatively with medication and PT, and there was no surgical indication. X- rays of the right shoulder on 19 November 2007 were normal. A right shoulder MRI, dated 20 December 2007, showed no labral tear or rotator cuff injury. At a sports medicine clinic visit on 2 June 2008, the CI noted anterior right shoulder pain without instability or dislocations. Examination was normal without tenderness and with a full ROM without pain. Examination on 13 June 2008 revealed tenderness on the right bicipital groove. Despite treatment the right shoulder pain did not subside.

During the MEB orthopedic examination, the CI reported chronic right shoulder pain with overhead activities and in the parade rest position, but he denied instability. Physical examination showed forward flexion to 170 degrees and abduction to 170 degrees (normal 180 for both) with significant pain of the anterior aspect of his shoulder. Bilateral rotator cuff motor strength was normal and there was right bicipital tendon tenderness, but no shoulder instability

bilaterally. There was no acromioclavicular joint tenderness and no tenderness along the rotator cuff muscles. Testing was positive for biceps load, O’Brien’s (to determine a glenohumeral tear), Speed’s (to determine bicipital tendonitis) and Yergason’s (to determine biceps tendon pathology). Painful motion was not addressed. A bicipital injection consisting of anesthetics and a steroid provided 90% relief of his symptoms in the anterior shoulder, and internal rotation increased to T8. PT and medication were to be continued and heavy lifting greater than 10 pounds was to be avoided. The MEB NARSUM examination noted complaints of right shoulder pain. Physical examination revealed normal bilateral upper extremity motor strength. No ROMs were in evidence.

During the C&P examination the CI reported chronic right shoulder pain and stiffness. No particular dislocation or recurrent subluxation was noted. Physical examination showed some anterior tenderness, especially over the bicipital tendon region, but no ankylosis or instability. Repetitive right shoulder flexion and abduction were both 0-180 degrees with painful motion. There was no additional ROM loss due to pain after repetition, but pain increased with repetition.

The panel directed attention to its rating recommendation based on the above evidence. The PEB rated the right shoulder condition 10%, coded 5024 (tenosynovitis). The Navy PEB also listed “joint pain localized to the right shoulder” as a related Category II condition that contributed to the primary unfitting condition but was not separately ratable. The panel agreed the pain was properly subsumed under the overall rating for the right shoulder condition IAW §4.14. The VA rated the right shoulder condition 10%, analogously coded 5299-5201 (arm, limitation of motion), based on the C&P examination, citing painful motion.

The panel agreed that the VASRD §4.71a threshold for rating ROM impairment (5201) is “at shoulder level” (approximately 90 degrees from the side), and the STR and VA evidence did not support a 20% rating. However, there was sufficient STR and VA painful motion evidence IAW VASRD §4.59 to support a 10% rating as adjudicated by the PEB. The panel also agreed there was no impairment of the humerus (5202), or clavicle or scapula impairment (5203) to support a higher rating. After due deliberation, considering all 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 right shoulder condition.

BOARD FINDINGS. In the matter of the right knee condition and IAW VASRD §4.71a, the panel recommends no change in the PEB adjudication. In the matter of the right shoulder condition and IAW VASRD §4.71a, the panel recommends no change in the PEB adjudication. There are no other conditions within the panel’s scope of review for consideration. Therefore, the panel recommends no modification or re-characterization of the CI’s disability and separation determination.

DEPARTMENT OF THE NAVY
SECRETARY OF THE NAVY COUNCIL OF REVIEW BOARDS 720 KENNON STREET SE STE 309
WASHINGTON NAVY YARD, DC 20374-5023

IN   REPLY   REFER  TO ,
1850
CORB: 003 20May20

From: Director, Secretary of the Navy Council of Review Boards

Subj:  PHYSICAL DISABILITY  BOARD OF REVIEW (PDBR)

Ref:	(a) DoDI 6040.44
(b) PDBR ltr dtd 27 Dec 18

1.	Pursuant to reference (a), the PDBR reviewed your case and forwarded its recommendation (reference (b)) to the Department of the Navy on 5 Mar 2020 for appropriate action.

2.	On 20 March 2020, the Assistant Secretary of the Navy (Manpower & Reserve Affairs) accepted the recommendation of the PDBR ofno change to your characterization of separation or disability rating assigned by the Department of the Navy's Physical Evaluation  Board.

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