RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME: XXXX			BRANCH OF SERVICE: marine corps
CASE NUMBER:  PD0900714			SEPARATION DATE: 20080715
BOARD DATE: 20110217

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was a USMC PFC/E-2 (9900, Recruit) medically separated in July 2008 after six months of service.  The medical basis for separation was right knee pain.  His knee problem began in January 2008 during the first few weeks of basic training when he suffered a buckling injury to his right knee while doing walking lunges.  He presented with lateral knee pain in his right knee.  X-rays of the right knee were negative.  Magnetic Resonance Imaging (MRI) of the right knee (February 2008) revealed a contusion of the medial femoral condyle.  In spite of treatment, his right knee pain failed to improve sufficiently for him to continue his training.  The CI underwent a Medical Evaluation Board (MEB).  His right knee condition was forwarded to the Physical Evaluation Board (PEB) as medically unacceptable.  The PEB adjudicated the right knee condition as unfitting, rated 10% IAW with the Veterans Administration Schedule for Rating Disabilities (VASRD).  The CI accepted the PEB findings and was medically separated.  

CI CONTENTION:  The CI states, “Didn’t include left knee injury and injury was more severe than they document.  It’s been a year and ten months since injury and still have a hard time walking. The right knee pain is still the same as the day I injured it.  Currently taking morphine and only slight decrease in the sharpness of pain, injury happened during recruit training and medical treated me as it was Marine it up and didn’t try or listen to me about what was going on.”

RATING COMPARISON:

Navy PEB (dated 20080616)	VA (6 mo. Post-Separation) – Effective 20080715	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Right Knee Medial Femoral Condyle Bone Contusion	5099-5003	10%	Patellofemoral Syndrome, Right Knee	5260	10%	20090114	
No additional PEB entries
	Traumatic Arthritis, Left Knee	5010-5260	10%	20090114	
	Mood Disorder	9435	30%*	20090202	
TOTAL Combined:  10%	TOTAL Combined: 50%	
  * Effective 20090202

ANALYSIS SUMMARY:  

Right Knee Condition.  As noted above, the right knee problem began during basic training.  Many treatment modalities were tried including, physical therapy (PT), transcutaneous electrical nerve stimulation (TENS), orthopedic brace, non-steroidal anti-inflammatory drugs (NSAIDs) and steroid injections.  It was recommended that he undergo diagnostic arthroscopy.  However, he refused to have arthroscopic surgery.  Two examinations and range of motion (ROM) evaluations of the right knee were in evidence, which the Board weighed in arriving at its rating recommendation.  The MEB right knee examination was three months pre-separation.  At that exam, there was no deformity, edema, erythema, color changes, ecchymosis or effusion.  His neurovascular exam, ligaments, and extensor mechanism were all intact.  Patellar apprehension test was negative, but the patellar compression test was positive.  There was no tenderness to palpation (TTP) at the medial and lateral joint line and McMurray's was negative.  There was no opening with varus stress at 0 and 30 degrees, and negative Tinels at the fibular head.  Right knee flexion was 135⁰ (140⁰ is normal) and extension was 0⁰ (normal).  The ROM results are summarized in the table below.

Right Knee	Separation Date: 20080715	
Goniometric ROM	MEB – 20080318	VA C&P - 20090114	
Flexion  (140⁰ is normal)	135⁰	130⁰ 	
Extension  (0⁰ is normal)	0⁰	0⁰	
§4.71a Rating	10%	10%	
Comments	10% rating based on painful motion	10% rating based on painful motion	

The VA Compensation & Pension (C&P) examination of the right knee was on 14 January 2009 (six months post-separation).  At that exam, there was no edema, crepitus, or instability.  Drawer sign was negative.  Right knee flexion was 130⁰ (140⁰ is normal) and extension was 0⁰ (normal).  Based on that examination, the VA assigned a 10% disability rating to the right knee. 

The Board evaluated all evidentiary information available.  It was noted that the Navy PEB and the VA chose different coding options for the right knee, but both assigned a 10% disability rating. At the time of separation from service, the CI was clearly experiencing persistent right knee pain, with some limitation of motion.  There was no documented objective evidence of ligamentous laxity or joint instability.  The ROM limitation did not meet VASRD criteria for a disability percentage (based upon knee and leg codes, 5260 through 5261).  However, IAW VASRD §4.59 and §4.71, when limitation of motion of a specific involved major joint is noncompensable under the appropriate diagnostic code, a rating of 10% is appropriate if there is satisfactory evidence of painful motion.  After due deliberation and careful consideration of all available evidence, the Board unanimously recommends a separation rating of 10% for right knee pain.  

Left Knee Condition.  CI complained of some left knee pain in February 2008.  At that time, the left knee was examined, x-rayed, and no pathology was found.  On the DD Form 2807-1 (dated 9 April 2008), CI listed right knee pain, but made no mention of left knee.  On the DD Form 2808 (Report of Medical Examination) dated 10 April 2008, there is no evidence of any abnormality involving the left knee.  During the C&P exam on 14 January 2009 (six months post-separation) the CI’s left knee was normal.  There was no edema, no tenderness to palpation (TTP), no crepitus, no instability, and a negative Drawer test.  He fully extended to 0⁰ with no pain, and he fully flexed to 140⁰ with no pain.  The Board unanimously agrees that the left knee was not unfitting at the time of separation from service and is not relevant for disability rating.

History of Other Conditions (documented in Disability Evaluation System (DES) package).  Several additional conditions were identified in the DES file.  None of these other conditions were under active treatment during the MEB period and none were implicated in the Commander’s statement.  These other conditions were all reviewed by the Action Officer and were considered by the Board.  There is no clearly documented evidence that any of these conditions caused a significant adverse effect on the performance of required military duties.  These other conditions are all judged by the Board to be not unfitting at the time of separation from service, and are not relevant for disability rating.  The Board, therefore, has no reasonable basis for recommending any additional unfitting conditions for separation rating.

History of Other Conditions (not documented in DES package).  Mood disorder was also noted by the Board.  There is no clearly documented evidence that this condition was a matter of record in the DES package.  Therefore, mood disorder is judged to be outside the scope of this Board. 

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 Board to the extent they were inconsistent with the VASRD in effect at the time of the adjudication.  The Board did not surmise from the record in this case that any prerogatives outside the VASRD were exercised.

In the matter of the right knee condition and IAW VASRD §4.71a, the Board unanimously recommends no change in the PEB adjudication.  

In the matter of the left knee condition or any other medical conditions eligible for Board consideration, the Board unanimously agrees that it cannot recommend any findings of unfit for additional rating at separation. 

Mood disorder (rated by the VA) was not a matter of record in the DES package and is, therefore, outside the scope of the Board.  

RECOMMENDATION: The Board, therefore, recommends that there be no re-characterization of the CI’s disability and separation determination.

UNFITTING CONDITION	VASRD CODE	RATING	
Right Knee Pain	5099-5003	10%	
COMBINED	10%	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20091201, w/atchs.
Exhibit B.  Service Treatment Record.
Exhibit C.  Department of Veterans' Affairs Treatment Record.

                            			

MEMORANDUM FOR DIRECTOR, SECRETARY OF THE NAVY COUNCIL OF REVIEW               
                                         BOARDS 

Subj:  PHYSICAL DISABILITY BOARD OF REVIEW (PDBR) RECOMMENDATION ICO   
          XXXX, FORMER USMC, XXX XX XXXX

Ref:   (a) DoDI 6040.44
             (b) PDBR ltr dtd 8 Mar 11

      I have reviewed the subject case pursuant to reference (a) and, for the reasons set forth in reference (b), approve the recommendation of the Physical Disability Board of Review Mr. XXX’s records not be corrected to reflect a change in either his characterization of separation or in the disability rating previously assigned by the Department of the Navy’s Physical Evaluation Board.