RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXXX	CASE:  PD-2014-00158
BRANCH OF SERVICE:  MARINE CORPS	BOARD DATE:  20150526
SEPARATION DATE:  20070531

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E-3 (Rifleman) medically separated for a right knee condition.  The 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 “other tear of cartilage or meniscus of knee, current,” was forwarded to the Physical Evaluation Board (PEB) IAW SECNAVINST 1850.4E.  The MEB also identified and forwarded one other condition (see rating chart below) for PEB adjudication.  The Informal PEB adjudicated the right knee condition as unfitting, rated 10%, with likely application of the Veterans Affairs Schedule for Rating Disabilities (VASRD).  The remaining condition was determined to be Category II, contributing to unfit.  The CI made no appeals and was medically separated.

CI CONTENTION:  “The VA only accepted my hernia as a disability.  My RT knee was not declined for some reason.  The VA has my medical records as evidence.  But gave me 0% for RT knee.”

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 conditions 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 Military/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 post-separation progression or complications of service-connected conditions.  That role and authority is granted by Congress to the Department of Veterans Affairs, operating under a different set of laws.  The Board gives consideration to VA 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 20070411	VA* - (~3 Mos. Post-Separation) 	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Right Knee Medial Meniscus Tear, Status Post Attempted Repair	5299-5003	10%	Right Knee Post Traumatic Surgical Arthralgia	5010	0%	20070820	
Right Knee Meniscal Cyst (Ganglion), Status Post
Attempted Repair	Cat II					
Other x 0 (Not In Scope)	Other x 2	
RATING:  10%	RATING:  20%	
*Derived from VA Rating Decision (VARD) dated 20071206 (most proximate to date of separation [DOS]).

ANALYSIS SUMMARY:

Right Knee Condition.  The CI originally had a twisting injury to his right knee while running in September 2005.  A magnetic resonance imaging revealed a torn medial meniscus.  His condition was surgically addressed on 9 February 2006, followed by rehabilitative therapy.  Initially he did well whereby his painful symptoms were decreased (not resolved) and within 3 weeks after surgery he was back to work “without difficulty.”  Despite aggressive physical therapy, he maintained a low-level constant right knee pain and eventually underwent a MEB.  At the narrative summary examination on 13 March 2007; 10 weeks prior to separation, the CI reported right knee pain aggravated by strenuous activities or attempted running, squatting or climbing.  Physical examination (PE) revealed joint line tenderness and a painful McMurray (meniscal tear test)…indicating painful motion.  Range-of-motion (ROM) was minimally decreased.  The right knee ligaments were stable and strength and sensation were intact.  The commander’s non-medical assessment indicated that the CI’s medical condition precluded him from standing a post and participating in most physical activities, which is a requirement for an Infantryman.

At the VA Compensation and Pension examination on 20 August 2007; approximately 3 months after separation, the CI reported right knee pain with walking and maneuvering stairs.  He admitted to some locking of the knee, but denies instability and or painful flare-ups.  “He [the CI] cannot run.”  “Employment is affected in that [the CI] has to stop work several times a day and rest his knee.  This decreases his productivity.”  The VA PE was clinically detailed and completely normal to include ROM.  The diagnosis was listed as post-traumatic post-surgical knee arthralgia.  Although subjectively present, there were no reported estimates of functional limitations.  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.

Right Knee ROM
(Degrees)	MEB ~3 Mo. Pre-Sep
(20070313) 	VA C&P ~3 Mo. Post-Sep
(20070820) 	
Flexion (140 Normal)	130	140	
Extension (0 Normal)	0	0	
Comment	tenderness; 
painful motion (reproducible)	-	
§4.71a Rating	10%	0%	

The Board directed attention to its rating recommendation based on the above evidence.  The PEB assigned a 10% rating under an analogous 5003 code (degenerative arthritis).  Using code 5010 (traumatic arthritis), the VA assigned a 0% rating citing the absence of abnormal compensable findings.  While there was no evidence of compensable limitation of motion, the Board agreed that the PEB’s 10% rating was supported under the 5003 coding pathway by sufficient evidence of painful motion (§4.59); or alternatively, possibly under the 5259 code (cartilage, semilunar, removal of, symptomatic) due to meniscal debridement/repair surgery.  It was also considered and agreed that frequent locking of the left knee due to dislocated semilunar cartilage was not present nor was an effusion, and therefore a 20% rating was not justified under the 5258 code.  Absent instability or compensable limitation of motion, the Board agrees that there are no available alternative joint or analogous coding options which are applicable and or advantageous to the CI’s current 10% rating.  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 right knee condition.

Other PEB Condition.  The right knee meniscal cyst (Ganglion) was adjudicated by the PEB as a related Category II condition.  The Board unanimously agreed that the condition was related and included in the discussion above and therefore do not warrant consideration as a separately unfitting condition.  All related symptoms and functional impairments were subsumed under the rating for the right 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 right knee condition and IAW VASRD §4.71a, the Board unanimously recommends no change in the PEB adjudication.  In the matter of the contended right knee meniscal cyst (Ganglion) condition, the Board unanimously recommends no change from the PEB determination as a Category II condition.  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 20140104, 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 20 Aug 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 USN
- XXXXXXXXXXXXXXX, former USMC
- XXXXXXXXXXXXXXX, former USMC
- XXXXXXXXXXXXXXX, former USN
- XXXXXXXXXXXXXXX, former USMC
- XXXXXXXXXXXXXXX, former USN
- XXXXXXXXXXXXXXX, former USN
- XXXXXXXXXXXXXXX, former USMC
- XXXXXXXXXXXXXXX, former USMC
- XXXXXXXXXXXXXXX, former USN
- XXXXXXXXXXXXXXX, former USN