RECORD OF PROCEEDINGS PHYSICAL DISABILITY BOARD OF REVIEW
NAME:  XXXXXXXXXXXXXXXXXXXXXXXXXXXX	CASE: PD-2017-03217
BRANCH OF SERVICE: MARINE CORPS	SEPARATION DATE: 20080515

SUMMARY OF CASE: Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E5, Counterintelligence Specialist, medically separated for “left patellofemoral syndrome” with a disability rating of 10%.

CI CONTENTION:  Review 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 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 - 20080303	VARD - 20081218	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Left Patellofemoral Syndrome	5299-5003	10%	Left Knee Sprain	5260-5019	10%	20080917	
COMBINED RATING: 10%	COMBINED RATING OF ALL VA CONDITIONS: 10%	

ANALYSIS SUMMARY:

Left Patellofemoral Syndrome. According to the service treatment record and MEB narrative summary (NARSUM), the CI underwent left knee surgery in June 2006 with tibial tubercle osteotomy and medial tibial retinacular ligament imbrication. Post-operative X-rays in August 2006 revealed left knee effusion with no evidence of left tibia hardware failure. The CI underwent hardware removal in December 2006. Post-operatively, he complained of slight soreness and swelling, but felt better with the screws out. The 20 November 2007 orthopedic examination revealed no effusion or tenderness, and full range of motion (ROM) without instability.

The 9 January 2008 MEB NARSUM examination, 4 months prior to separation, noted complaints of left knee pain associated with numbness. Physical examination showed no focal tenderness and no effusion. The left patella was hypermobile, but so was the right patella. The CI noted numbness from his quadriceps to his anterior tibia, not along the joint line. He had 5/5 strength, ROM was “full,” and the left knee was ligamentously stable. Painful motion was not addressed. X-rays showed healed osteotomy.

At the 17 September 2008 VA Compensation and Pension (C&P) examination, 4 months after separation, the CI reported progressively worsening left knee pain. Physical examination showed a normal gait without instability.   The ROM evaluation showed flexion of 125 degrees   (normal
140)	and extension of 0 degrees (normal 0) with pain. There was no additional loss of motion upon repetition due to pain, weakness, fatigueability, lack of endurance or incoordination. An MRI noted a small joint effusion without acute fracture, meniscal tear or ligament tear.

The panel directed attention to its rating recommendation based on the above evidence. The PEB rated the left knee condition 10%, analogously coded 5299-5003 (arthritis, degenerative). The VA also rated the left knee condition 10%, dual coded 5260-5019 (leg, limitation of flexion of-bursitis), based on the C&P examination, citing painful limitation of the knee joint. 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). The examinations proximate to separation did not demonstrate the presence of ligamentous instability or laxity (5257), and 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, 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). 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 left knee condition.

BOARD FINDINGS: In the matter of the left knee 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.

The following documentary evidence was considered:

2	PD-2017-03217

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 14 May 19

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 of no 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.

Copy to: PDBR