RECORD OF PROCEEDINGS PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXXXXX		CASE: PD-2017-04024 BRANCH OF SERVICE: MARINE CORPS	SEPARATION DATE: 20070531

SUMMARY OF CASE: Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E6, Personnel Clerk, medically separated for “left knee patellofemoral dysfunction” with a disability rating of 10%.

CI CONTENTION: She requested that both knees/legs be considered as unfitting. 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 - 20070109	VARD - 20080712	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Left Knee Patellofemoral Dysfunction	5299-5003	10%	Left Knee Patellofemoral Dysfunction	5299-5261	0%	20080326	
COMBINED RATING: 10%	COMBINED RATING OF ALL VA CONDITIONS: 40%	

ANALYSIS SUMMARY:

Left Knee Patellofemoral Dysfunction. According to the service treatment record and MEB narrative summary (NARSUM), the CI underwent a Fulkerson procedure (to re-align the lower bony attachment of the patellar tendon on the shinbone) in August 2005 for an acute patellar dislocation. The 17 October 2005 physical therapy examination noted complaints of pain, rated from 6-8/10, that worsened with running, walking, standing, and going up/down stairs. Physical examination  revealed  an  abnormal  gait  with  decreased  left  knee  flexion  in  swing    during

ambulation, and decreased left knee extension in stance. Range of motion (ROM) showed flexion from -10 to 134 degrees (normal 0-140).

At the 20 June 2006 family practice appointment, 11 months prior to separation, the CI reported pain that was worse with full extension or walking, and a burning electric sensation in the lateral left calf and thigh. There was no tenderness, and as long as she did not wear combat boots, there was no pain. She reported being unhappy with the results of the knee surgery and wanted a second opinion, as the chronic pain was going to result in being dismissed from the military. Left knee ROM was normal, but painful motion was not addressed. Lachman’s and varus/valgus testing was negative for instability.

During the 24 November 2006 MEB NARSUM examination, 6 months before separation, the CI reported being able to tolerate walking for 45 minutes or 2 miles, and that standing or sitting greater than 2 hours increased pain. She also had pain when maneuvering stairs and occasional giving way. Physical examination showed flexion of 130 degrees and extension of 0 degrees; painful motion was not addressed. There was no effusion, pes anserine pain, or patellar grind, apprehension, or tendon pain. Anterior/posterior drawer, Lachman’s, and McMurray's testing was negative. Knee X-rays were normal outside of evidence of the surgery. At the 2 December 2006 MEB examination (recorded on DD Forms 2807-1 and 2808), the CI complained of numbness and tingling in the left leg since surgery. The examiner noted an abnormal patellar track and diagnosed patellar femoral syndrome.

At the 26 March 2008 VA Compensation and Pension (C&P) examination, 10 months after separation the CI reported pain with prolonged standing. Physical examination showed a normal gait and ROM from 0-140 degrees, with pain but no additional loss of motion with repetitive use. Motor and sensory findings were normal and there was no effusion.  Knee X-rays were normal.

The panel directed attention to its rating recommendation based on the above evidence. The PEB rated the left knee condition 10%, analogously coded as 5003 (degenerative arthritis). The VA rated the left knee condition 0%, analogously coded as 5261 (limitation of extension of the leg), based on the C&P examination, citing normal ROM. Panel members noted there was no limitation of flexion or extension (5260, 5261) which supported a compensable rating, but there was evidence of painful motion with functional loss supporting a 10% rating (based on §4.40,
§4.45 and §4.59). There was no history or evidence of dislocated meniscus or loose body causing frequent locking with recurrent effusions (5258), or 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 rating higher than the 10% adjudicated by the PEB under any applicable code. 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.

 	

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 3 Apr 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.

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