RECORD OF PROCEEDINGS PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXXXXXXX		CASE: PD-2017-02863 BRANCH OF SERVICE: MARINE CORPS	SEPARATION DATE: 20090830

SUMMARY OF CASE: Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E5, Field Radio Operator, medically separated for “patellofemoral syndrome right [knee]” with a disability rating of 10%.

CI CONTENTION: Review requested of the right knee, hearing, neck, headache, TMJ [temporomandibular joint] and back conditions, as well as additional conditions not identified by the Medical Evaluation Board (MEB) and Physical Evaluation Board (PEB) was 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 PEB to be unfitting for continued military service, and when specifically requested by the CI, those conditions identified by the 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 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 - 20090708	VARD - 20091005	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Patellofemoral Syndrome, Right Knee	5099-5019	10%	Right Knee Patellofemoral Syndrome	5099-5019	10%	
20090326	
Medial Plica Syndrome, Right Knee	Cat II					
Lumbosacral Strain	
Cat III	Lumbosacral Strain	5237	0%		
Tinnitus		Tinnitus	6260	10%	
20090407	
Hearing Loss, Right Ear		Right Ear Hearing Loss	6100	0%		
Bilateral TMJ Disc Displacement		TMJ Disc Displacement	9905	0%		
Headaches	Not Unfitting	No VA Placement	
Neck Condition, Limited Motion			
COMBINED RATING: 10%	COMBINED RATING OF ALL VA CONDITIONS: 20%	

ANALYSIS SUMMARY:

Right Knee Patellofemoral Syndrome. According to the service treatment record and MEB narrative summary (NARSUM), the CI’s right knee condition began in December 2008 after playing basketball with gradual worsening of the injury. Despite numerous physical therapy treatments, he was unable to return to full duty in his military specialty. In March 2009, an X-ray revealed slight narrowing of the medial joint, but otherwise negative results, and an MRI showed a prominent medial plica, but no other abnormalities. The 20 May 2009 MEB NARSUM examination, 3 months prior to separation, noted complaints of right knee pain, worsened by

running, jogging and going up stairs. Physical examination showed parapatellar tenderness and positive patellar grind, and flexion was to 135 degrees (normal 140), with anterior pain, and hyperextension to 3 degrees (normal 0).

At the 26 March 2009 VA Compensation and Pension (C&P) examination, 5 months before separation, the CI reported constant right knee pain, rated up to 8/10 during flare-ups. Symptoms included weakness, swelling, giving way and lack of endurance, with pain exacerbated by physical activity and relieved by rest. He was able to function without medication, but could not run and had difficulties with stairs. Physical examination showed normal ROM with no painful motion, but there was evidence of retropatellar pain, fatigue and lack of endurance after repeated use. The major functional impact was pain.

The panel directed attention to its rating recommendation based on the above evidence. The PEB incorporated the VA Rating Decision letter rationale regarding the unfitting condition, and rated the right knee condition 10% analogously coded 5019 (bursitis). The PEB also listed “medial plica syndrome, right knee” as a related Category II condition (contributes to the primary unfitting condition but not separately ratable), and panel members agreed this impairment was properly subsumed under the overall rating for the right knee IAW §4.14 (avoidance of pyramiding; more than one rating based on the same impairment is prohibited). The VA also rated the right knee condition 10%, analogously coded 5019, based on the C&P examination, citing painful and slightly limited motion of a major joint. The panel noted that while there was no compensable limitation of flexion or extension (5260 or 5261), there was evidence of painful motion with functional loss supporting a 10% rating (based on §4.59, §4.40 and §4.45). Panel members considered other VASRD knee and analogous codes, but all were less applicable and/or not advantageous for 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 knee condition.

Contended PEB Conditions: Lumbosacral Strain, Tinnitus, Hearing Loss, Right Ear, Bilateral TMJ Disc Displacement, Headaches, and Neck Condition (Limited Motion). The panel’s main charge is to assess the fairness of the PEB determination that the contended conditions were not unfitting. None of the conditions were noted on limited duty forms or implicated in the non-medical assessment, and did not fail retention standards. There was no performance-based evidence from the record that any of the conditions significantly interfered with satisfactory duty performance at separation. After due deliberation, the panel concluded there was insufficient cause to recommend a change in the PEB fitness determinations for any of the contended conditions, so no additional disability ratings are recommended.

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 contended lumbosacral strain, tinnitus, hearing loss, right ear, bilateral temporomandibular joint disc displacement, headaches and neck condition (limited motion), the panel recommends no change from the PEB determinations as not unfitting. 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.

The following documentary evidence was considered:

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

IN REPLY REFER TO:

1850
CORB: 003
10 Sep 20

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

Subj: PHYSICAL 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 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.