RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXXX	CASE:  PD-2013-01933
BRANCH OF SERVICE:  MARINE CORPS	BOARD DATE:  20150414
SEPARATION DATE:  20040320

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was a Reserve E-8 (Infantry; Assault Man; Reconnaissance Man) medically separated for left knee condition.  This condition could not be adequately rehabilitated to meet the physical requirements of his Military Occupational Specialty or satisfy physical fitness standards.  He was placed on limited duty and referred for a Medical Evaluation Board (MEB).  The “degenerative arthritis left knee,” was forwarded to the Physical Evaluation Board (PEB) IAW SECNAVINST 1850.4E.  No other condition was submitted by the MEB.  The Informal PEB (IPEB) adjudicated “degenerative arthritis left knee” as unfitting, rated 10% with application of the Veterans Affairs Schedule for Rating Disabilities (VASRD).  The CI made no appeals, and elected transfer to the Retired Reserve awaiting retired pay in lieu of disability severance pay.

CI CONTENTION:  The CI contends for a higher rating for his left knee degenerative arthritis.  In addition he contends for service ratings for other joints, prostate cancer, and head injury.

SCOPE OF REVIEW:  The Board’s scope of review is defined in DoDI 6040.44, Enclosure 3, paragraph 5.e.(2).  It is limited 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 PEB, but determined to be not unfitting.  Any condition outside the Board’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 Naval Records.  Furthermore, the Board’s authority is limited to assessing the fairness and accuracy of PEB rating determinations and recommending corrections, where appropriate.  The Board’s assessment of the PEB rating determinations is confined to review of medical records and all available evidence for application of the VASRD standards to the unfitting medical condition at the time of separation.  The Board has neither the role nor the authority to compensate for after separation progression or complications of service-connected conditions.  That role and authority is granted by Congress to the Department of Veterans Affairs (DVA), operating under a different set of laws.  The Board gives consideration to DVA evidence, particularly within 12 months of separation, but only to the extent that it reasonably reflects the severity of the disability at the time of separation.

RATING COMPARISON:

IPEB – Dated 20040128	VA* - (~7 Yrs. Post-Separation)	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Degenerative Arthritis Left Knee	5010-5003	10%	Left Knee Osteoarthritis, s/p Operative	5260-5010	10%	20110309	
Other x 0 (Not In Scope)	Other x 26	
RATING:  10%	RATING:  70%	
*Derived from VA Rating Decision (VARD) dated 20120817

ANALYSIS SUMMARY:

Degenerative Arthritis Left Knee.  The MEB narrative summary examination dated 20 November 2003, approximately 6 months prior to separation, detailed that the CI suffered a left knee injury in 1978 (prior to service) with resultant instability.  He had surgery of the ligaments and cartilage at that time (ligament reconstruction and partial lateral meniscectomy).  In January 1993 he had arthroscopic repair (debridement) of extensive chondromalacia (abnormal softening of cartilage in the joint) and partial medial and lateral meniscectomy, when he probably was not on active duty status.  After this surgery he did well including running several marathons.  While deployed to Iraq he jumped off a tank on or about 19 May 2003, and noted immediate swelling, constant ache, and feeling of instability and giving way of the left knee; but was not immediately medically evaluated.  On initial presentation to orthopedics on 28 October 2003 he was noted to have some medial joint line tenderness.  There was no swelling, effusion (fluid in the knee joint), and the ligaments were normal without instability.  X-rays revealed some degenerative changes consistent with osteoarthritis, and magnetic resonance imaging showed damage to the medial and lateral menisci.  He underwent arthroscopic surgery on 31 October 2003 with repair (chondroplasty) of extensive chondromalacia of the femur and tibia, and debridement of medial and lateral meniscal tears.  Physical examination (by orthopedics) on 18 November 2003, 3 weeks after surgery, showed trace effusion, fair quadriceps muscle tone, and range-of-motion (ROM) from 0 to 100 degrees (normal 0 to 140).  Examination by orthopedics on 5 December 2003 showed non-antalgic (non-painful) gait, ROM from 0 to 125 degrees, trace effusion, and good quadriceps muscle tone.

At the MEB examination dated 16 December 2003, approximately 3 months prior to separation; the CI reported arthritis in the knee.  Examination of the lower extremities was normal except for a surgical scar of the left knee.  At a post-operative orthopedic visit on 16 January 2004, the CI reported that he was walking and running on a treadmill.  On examination, gait was normal, ROM was 0 to 130 degrees (compared to 0 to 140 on the right), the quadriceps muscle had good tone and no atrophy, and there was no joint effusion.  The CI was seen in orthopedics on 12 March 2004, a week prior to separation, stating that his left knee function was normal with minimal pain and no swelling and that he wanted to return to full duty and forgo the PEB.

At a VA primary care visit on 6 August 2004, 5 months after separation, the CI had normal gait, normal strength of the lower extremities, full ROM of the knees without pain, no swelling or erythema, and negative McMurray sign (testing for tears of the meniscus).  VA examinations over 5 years later in 2009 and 2010 recorded increased symptoms.  The examination on 5 March 2009 (5 years after separation) showed normal gait, no laxity of the knee, and tenderness on the medial aspect of the knee and over the patella.  A VA C&P examination of the left knee in October 2010 recorded extension of 0 degrees and flexion to 120 degrees with pain beginning at 90 degrees of flexion.  There was crepitus but no instability.  A VA C&P examination in March 2011 detailed crepitus, no subluxation, and the same ROM.

The Board directed attention to its rating recommendation based on the above evidence.  The IPEB rated the left knee condition 10%, coded 5010-5003 (arthritis, due to trauma – arthritis, degenerative; the code is written “8003” an apparent typographical error).  Over 6 years after separation, the VA rated the condition 10%, coded 5260-5010 (limitation of flexion of leg - arthritis, due to trauma) citing painful motion and functional loss and X-ray evidence of traumatic arthritis.  Although the VA C&P exams of October 2010 and March 2011 were of limited probative value due to the remoteness from the date of separation, they did not indicate the knee condition was more severe at the time of separation than portrayed by the examinations more proximate to separation.  There was no limitation of flexion or extension that supported a minimum rating under the VASRD diagnostic codes for limitation of motion (codes 5260, 5261).  There was evidence of painful motion with functional loss supporting the 10% rating (based on §4.59 painful motion, §4.40 functional loss and §4.45 joints) adjudicated by the PEB and subsequently the VA using codes rated under 5003.  The Board also noted a 10% rating was supported under VASRD diagnostic code 5259 (cartilage, semilunar, removal of, symptomatic) but provided no benefit to the CI.  The exams proximate to separation did not demonstrate the presence of ligamentous laxity, frequent effusions, or locking (or any indication of loose body).  Thus, there was no VASRD §4.71a route to a rating higher than 10% under any applicable code, and no grounds for additional rating of instability.  After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the Board concluded that there was insufficient cause to recommend a change in the PEB’s adjudication for the left knee condition.

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 or PEB ruling in this case that any prerogatives outside the VASRD were exercised.  In the matter of the left knee condition and IAW VASRD §4.71a, the Board unanimously recommends no change in the PEB adjudication.  There were no other conditions within the Board’s scope of review for consideration.

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

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20130820, 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 
Ref:	(a) DoDI 6040.44
(b) CORB ltr dtd 2 Jul 15

In accordance with reference (a), I have reviewed the cases forwarded by reference (b), and, for the reasons provided in their forwarding memorandums, approve the recommendations of the PDBR that the following individual's records not be corrected to reflect a change in either characterization of separation or in the disability rating previously assigned by the Department of the Navy' s Physical Evaluation Board:

-	XXXXXXXXXXXXXXXXXXXX, former USN
-	XXXXXXXXXXXXXXXXXXXX, former USN
-	XXXXXXXXXXXXXXXXXXXX, former USN
-	XXXXXXXXXXXXXXXXXXXX, former USN
-	XXXXXXXXXXXXXXXXXXXX, former USMC
-	XXXXXXXXXXXXXXXXXXXX, former USMC