RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME: XXXXXXXX	BRANCH OF SERVICE: Marine corps
CASE NUMBER:  PD200900352	BOARD DATE: 20090916
SEPARATION DATE: 20040930
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SUMMARY OF CASE:  This covered individual (CI) was a Sergeant Field Radio Operator medically separated from the Marine Corp in 2004 after more than thirteen years of service in the Marine Corps and the Army.  The medical basis for the separation was Medial Meniscus Transplant.  CI was referred to the Navy Physical Evaluation Board (PEB), found unfit, and separated at 10% disability.

MEDICAL HISTORY:  The CI was first seen for right knee pain in May 1990. In May of 2000 he had positive Lachman's sign and anterior drawer sign of the right knee. The CI underwent ACL reconstruction in August 2000, at which time he underwent partial medial meniscectomy.  Unfortunately, he continued to re-tear his medial meniscus and underwent complete medial meniscectomy of his right knee in July 2003 und continued to remain symptomatic in his medial compartment, despite an adequate postoperative rehabilitation program.  Based on these findings, a decision was made to perform a medial meniscal transplant.  After this surgery he did well with unlimited ambulatory tolerance and was able to perform light weight squats and leg presses without complaints at three months postoperative.  However, the orthopedic surgeon cautioned that this meniscal transplant is considered a temporary measure to gain time before performing a knee replacement and that the CI should not engage in any strenuous activity such as running, impact loading activities, and carrying heavy loads.  He strongly recommended the CI be medically separated.  So while the CI was doing well his activities were still severely restricted.

The Informal PEB initially determined he was fit for continued military service.  However, upon reconsideration with further evidence from the Senior Medical Board Orthopedic Surgeon the PEB determined the CI was unfit and he was then separated with a 10% disability for 5299-5003 Medial Meniscus Transplant using the Veterans Affairs Schedule for Ratings Disabilities (VASRD) and applicable Navy and Department of Defense regulations.
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CI CONTENTION:  CI contends: “I do not feel the board was aware of the severity, and the permanent affect the procedure will have on my life and my employment limitations.  The board based on my doctor's comments in his Physical Evaluation Board Addendum slates the boards understanding of Medial Meniscal Transplant is clearly incomplete.  My Doctor stated I will need full knee arthroplasty in one to ten years from the date of my surgery.  My knee has been bothering me. I take narcotic pain medicine daily and wear knee braces.  So it is clear that soon I will need full knee replacement and I won't be able to work.  I have other medical problems as well but when my knee goes I don't know what kind of work I will be able to do.  I’m only forty and facing full knee replacement.  The VA does not seem to understand this procedure as well due the fact the VA rates my right knee as an ACL replacement, meniscal repair which I had in 2000.  There are limited doctors in the country that deal with this procedure.  So I am totally convinced that the board did not consider the employment and lifetime obstacles I’m facing with this condition and the board's findings were not appropriate and were unfair.  I request that PDBR read the Physical Evaluation Board Addendum that my Doctor wrote this will help to understand the procedure.  I also respectfully and humbly request the PDBR change my rating to at least the minimum required to receive some type of retirement benefits.  The severance pay I received when I was separated is taken out of my VA check monthly.  I am paying all of it back, so it is like I really got nothing.  I served nearly fourteen years and I gave One Hundred and Ten percent in everything I did while I was in the military. This took a very heavy toll on my mind and body.  The PDBR will see in box fourteen where I listed all my VA rated injuries and illnesses.  I have this condition that really no one but the doctor that did the procedure realizes the severity and permanent effect it has on my life.  This condition deteriorates as time passes it will not get better it will only worse as my doctor stated.”
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RATING COMPARISON:

Previous Determinations 	
Service	VA	
PEB Condition	Code	Rating	Date	Condition	Code	Rating	Exam Date	Effective date	
Medial Meniscus Transplant (7173) 	5299-5003	10%	20040721	Internal Derangement, Right Knee, Status Post Anterior Cruciate Ligament Repair, Meniscal Repair, with Chondromalacia and Degenerative Joint Disease	5010-5257

5010-5258

5210-5260
	10%

0%

20%

10%	20010109

20040923

20061016	20010412-20010711

Active Duty

20041001

20060405	
				Left Knee Strain associated with Internal Derangement,
Right Knee. status post Anterior Cruciate Ligament
Repair, Meniscal Repair, with Chondromalacia and Degenerative Joint Disease (Previously Rated Under DC
5010-5257)	5099-5019	0%	20061016	20060405	
				Degenerative Disc Disease. Cervical Spine	5242

5210
	0%

10%	

20040923	20041001

20060405	
				Bilateral Recurrent Inguinal Hernias, Status Post Surgical Repair	7338-7804	10%

	20010109	20010412	
				Torn Left Pectoralis Major Muscle	5302-5203	10%
	20040923	20041001	
				Musculotendinous Strain, Thoracolumbar Spine	5010-5237	10%

40%

	20040923

20061016	20041001

20070315	
				Asthma	6602	10%

30%	20040923

20061016	20041001

20070315	
				Post-Traumatic Vascular Headaches	8045-9304	10%	20040923	20041001	
				Hemorrhoids	7336	0%	20040923	20041001	
				Status Post Bilateral Inguinal Hernia Repairs with Residual Scars	7338-7805

7338-7804	0%

10%	20040923

20061016

	20041001

20060405
	
				Scars, Right Knee	7805	0%	20040923	20041001	
				Post Traumatic Stress Disorder	9411	30%
70%	
	20040405
20081007	
				Exposure To Asbestos	6899-6833	NSC	20040923		
				Exposure To Radiation	6899-6830	NSC	20040923		
									
TOTAL Combined:  10%	TOTAL Combined (incl non-PEB Dxs):   20% from 2001412
0% from 20010711 (Active Duty)                                                                 
                                                                                      50% from 20041001
                                                                                     60% from 20050915
                                                                                     90% from 20060405
                                                                                     80% from 20060415
90% from 20081007	
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ANALYSIS SUMMARY:
Right Knee Medial Meniscus Transplant
The Navy PEB rated this condition analogous to 5003 Degenerative Arthritis.  Using an evaluation completed prior to the time of separation from the Navy, the Veterans Administration (VA) rated this disability as 5010-5258 Internal Derangement, Right Knee, Status Post Anterior Cruciate Ligament Repair, Meniscal Repair, with Chondromalacia and Degenerative Joint Disease at 20%. This rating was based on knee pain, painful motion, and additional flares due to pain, fatigue, weakness, and lack of endurance after repetitive use.  He had limited mobility and his knee condition interfered with work and daily activities.

Neither the Navy nor VA examinations showed limit of knee range of motion (ROM) at the compensable level or knee instability.  However both documented similar levels of functional impairment as a result of the temporizing medial meniscus transplant and the CI’s other knee impairments.  The Navy Orthopedic Surgeon assigned a Cincinnati functional rating of 4 out of 10.  While the CI was able to perform most activities of daily living, he could not perform any activity beyond normal walking without pain and swelling and was in fact advised to limit his activities to prolong the usefulness of his transplant.
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BOARD FINDINGS: IAW DoDI 6040.44, provisions of DoD or Military Department regulations or guidelines relied upon by the PEB will not be considered by the PDBR to the extent they were inconsistent with the VASRD in effect at the time of the adjudication.  After careful consideration of all available information, the Board unanimously concluded that the CI’s condition is appropriately rated at a 20% for 5299-5258 Internal Derangement, Right Knee, Status Post Anterior Cruciate Ligament Repair and Medial Meniscal Transplant, with Chondromalacia Patella and Degenerative Joint.  

This rating is based on the inability to engage in activities beyond basic activities of daily living and walking limited distances without pain and swelling.  The CI cannot perform even moderately strenuous activities and cannot engage in sustained activity as repetitive use leads to increased pain, fatigue, weakness, and lack of endurance.  These functional limitations interfere with both work and daily living. 

The Board also examined left knee, torn pectoralis muscle, status post bilateral inguinal hernia repair, and scars from knee and hernia surgeries and did not find any of these conditions to be unfitting.  The other diagnoses rated by the VA were not mentioned in any PEB paperwork and could not be considered by the Board.
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RECOMMENDATION:  The Board recommends that the CI’s prior determination be modified as follows, effective as of the date of the CI’s prior medical separation.

Unfitting Condition	VASRD Code	Rating	
Internal Derangement, Right Knee, Status Post Anterior Cruciate Ligament Repair and  Medial Meniscal Transplant, with Chondromalacia Patella and Degenerative Joint Disease	5299-5258	20%	
Combined	20%	
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The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20090511, w/atchs.
Exhibit B.  Service Treatment Record.
Exhibit C.  Department of Veterans' Affairs Treatment Record.

	 

MEMORANDUM FOR DEPUTY COMMANDANT, MANPOWER & RESERVE 
                                        AFFAIRS

Subj:  PHYSICAL DISABILITY BOARD OF REVIEW (PDBR) RECOMMENDATION
          ICO XXXXXX

Ref:   (a) DoDI 6040.44

Encl:  (1) PDBR ltr dtd 29 Sep 09 

1.  I have reviewed the subject case pursuant to reference (a) and accept, in part, the recommendation of the Physical Disability Board of Review (enclosure (1)).

2.  Mr. XXXXX’s official records are to be corrected to reflect the following disposition:

	a. Separation from the naval service due to physical disability rated at 20% (vice 10%) effective 30 Sep 2005.

3.  Please ensure all necessary actions are taken to implement this decision and Mr. XXXX is notified once those actions are completed.