RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXX	CASE:  PD-2014-00096
BRANCH OF SERVICE:  MARINE CORPS	BOARD DATE:  20140812
SEPARATION DATE:  20071130

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty LCPL/E-3 (3051/Warehouse Clerk) medically separated for a chronic left knee condition.  The left knee 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 left knee condition, characterized as “chondromalacia of patella,” “tear of medial cartilage or meniscus of knee,” “pain in joint involving lower leg” and “unspecified orthopedic aftercare” were forwarded to the Physical Evaluation Board (PEB) IAW SECNAVINST 1850.4E.  No other conditions were submitted by the MEB.  The Informal PEB adjudicated “chronic knee pain” as unfitting, rated 20% with a 10% EPTS (existing prior to service) reduction.  Status post (s/p) anterior cruciate ligament (ACL) bone-patella-tendon bone reconstruction, left medial meniscus tear s/p medial meniscus repair and left Grade II chondromalacia patella were determined to be Category II conditions.  The CI made no appeals and was medically separated.

CI CONTENTION:  “I was rated at 30% when I was discharged from the Marine Corps.  Subsequently, the VA rated me at 40% for the same conditions.”

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 those conditions identified but not determined to be unfitting by the PEB when specifically requested by the CI.  The rating for the unfitting left knee condition is addressed below; and, no additional conditions are within the DoDI 6040.44 defined purview of the Board.  The VA service-connected (lumbosacral strain, right ankle and cervical spine conditions) were not identified by the MEB/PEB and thus are not within the DoDI 6040.44 defined purview of the Board.  Disability compensation may only be offered for those conditions that cut short the member’s career.  Any conditions or contention not requested in this application, or otherwise outside the Board’s defined scope of review, remain eligible for future consideration by the Board for Correction of Naval Records.

IAW DoDI 6040.44, the Board’s authority is limited to making recommendations on correcting disability determinations.  The Board’s role is thus confined to the review of medical records and all evidence at hand to assess the fairness of PEB rating determinations, compared to VA Schedule for Rating Disabilities (VASRD) standards, based on ratable severity at the time of separation.

RATING COMPARISON:

Service IPEB – Dated 20071016	VA - (4 Mos. Post-Separation)  	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Knee Pain	5299-5003	10%	Traumatic Arthritis Left Knee, Status Post-Operative Changes	5260	10%	20080318	
S/P Anterior Cruciate Ligament Bone-Patella-Tendon Bone Reconstruction	CAT II					
Left Medial Meniscus Tear, S/P Repair	CAT II					
Left Grade II Chondromalacia Patella	CAT II					
Other x 0 (Not in Scope)	Other x 3 	 	
Rating:  10%	Combined:  30%	
Derived from VA Rating Decision (VARD) dated 20080429 (most proximate to date of separation [DOS]).

ANALYSIS SUMMARY:

Left Knee Condition.  Prior to military service, the CI underwent a left ACL reconstruction after a sports related injury in November 2004.  He did well postoperatively with a return of full range-of-motion (ROM) within 5 months.  Six months after service entry he re-injured his left knee while hiking.  A magnetic resonance image dated January 2007 revealed normal post-surgical changes as well as a medial meniscal tear.  Upon orthopedic recommendation, the CI underwent a left arthroscopic meniscal repair and patellar (knee cap) debridement in June 2007.  Despite surgical correction, he continued to have left knee pain.  A physical therapy (PT) encounter dated 3 August 2007 noted the CI endorsed “constant pain” scaled at 6/10; worse after prolonged standing and walking.  The PT physical examination (PE) revealed a normal gait, the absence of atrophy or tenderness and minimal decreased ROM.

At the narrative summary examination of 30 August 2007 (3 months prior to separation), the CI reported left knee pain scaled at 7/10 while at rest.  Additionally, he endorsed pain with kneeling, attempting full flexion and locking with attempts to run.  His PE revealed joint-line and patellar tenderness, patellar grind and crepitus, and painful decreased ROM.  His gait was antalgic.  Instability tests were negative.  His diagnosis was chondromalacia (Grade II) of the patella and s/p previously mentioned surgical procedures.

At the VA Compensation and Pension examination of 18 March 2008, (4 months after separation), the CI reported constant left knee pain scaled 8/10 associated with subjective weakness and stiffness.  He reported the inability to walk greater than 10 minutes, play sports, lift weights or run.  Pain increased with stair climbing.  He denied dislocations, subluxations or instability of the knee.  His PE revealed global tenderness about the left knee with patellar grind and crepitus present.  Repetitive use increased his pain, but not weakness, fatigue or endurance.  ROM was decreased.  There was no guarding present and his gait was antalgic with a limp.  The diagnosis was traumatic arthritis of the left knee.  The goniometric ROM evaluations in evidence which the Board weighed in arriving at its rating recommendation, with documentation of additional ratable criteria, are summarized in the chart below.

Left Knee ROM
(Degrees)	MEB ~ 3 Mo. Pre-Sep
	VA C&P ~ 4 Mo. Post-Sep
	
Flexion (140 Normal)	115	105	
Extension (0 Normal)	-	0	
Comment	antalgic gait; crepitus;	painful motion;
antalgic gait	
§4.71a Rating	10%	10%	
The Board directs attention to its rating recommendation based on the above evidence.  After a 10% rating reduction for an EPTS condition, the PEB assigned a 10% rating under an analogous 5003 code (degenerative arthritis).  The VA also assigned a 10% rating under code 5260 (limited flexion) citing painful motion with arthritic changes and surgical intervention.  Although non-compensable limitation of motion was present near the time of separation, the MEB and VA examinations clearly indicated painful motion (§4.59) or pain on use (functional loss; §4.40) secondary to decreased ROM and or the presence of crepitus.  Board members agreed that a minimal compensable rating under either a specific joint code or an analogous 5003 code was therefore supported by application of §4.40.  In this case, Board members could not completely ascertain the rationale of the PEB’s original analogous 20% rating given neither the presence of incapacitating episodes nor involvement of two or more joints.  All members did agree that the totality of evidence in this case supported a clear-cut rating of 10% as described above.  Absent effusion, meniscal removal or documented instability, there was no route to an impairment rating higher than the final 10% under any other applicable knee codes.  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.

Other PEB Conditions.  Left Grade II chondromalacia patella, left medial meniscus tear s/p repair and s/p ACL bone-patella-tendon bone reconstruction were all adjudicated by the PEB as related Category II conditions.  The Board unanimously agrees that all of the conditions are related and included in the discussion above and therefore do not warrant consideration as separately unfitting conditions.  All related symptoms and functional impairments are subsumed under the rating for the left knee as noted above.

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 20131227, 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) RECOMMENDATIONS
 
Ref:   (a) DoDI 6040.44
       (b) CORB ltr dtd 11 Mar 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:

- XXXXXXXXXXXXXXX, former USMC
- XXXXXXXXXXXXXXX, former USMC
- XXXXXXXXXXXXXXX, former USN
- XXXXXXXXXXXXXXX, former USMC
- XXXXXXXXXXXXXXX, former USN