RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXX	CASE:  PD-2014-00229
BRANCH OF SERVICE:  MARINE CORPS	BOARD DATE:  20141016
SEPARATION DATE:  20060416

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty CPL/E-4 (3531/Motor Transport Operator) medically separated for disruption of posterior cruciate ligament.  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).  Health examination of defined subpopulation and unspecified internal derangement of knee were forwarded to the Physical Evaluation Board (PEB) IAW SECNAVINST 1850.4E.  No other conditions were submitted by the MEB.  The Informal PEB adjudicated “disruption of posterior cruciate ligament (PCL) treated with reconstruction, with symptomatic right knee laxity” as unfitting, rated 10% with likely application of the VA Schedule for Rating Disabilities (VASRD).  The CI made no appeals and was medically separated.

CI CONTENTION:  “PCL restruction. [sic]”  

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 disruption of posterior cruciate ligament condition is addressed below; no additional conditions are within the DoDI 6040.44 defined purview of the Board.  Any condition 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.

RATING COMPARISON:

Service IPEB – Dated 20060214	VA* - (2 Mos. Post-Separation)	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Disruption of Posterior Cruciate Ligament…with Symptomatic Right Knee Laxity	5262	10%	Right Knee Laxity	5257	10%	20060215	
			Status Post Right Knee Posterior Cruciate Ligament Reconstruction	5260	10%	20060215	
Other x 0 (Not in Scope)	Other x 3 (Not in Scope)	20060215	
Combined:  10%	Combined:  20%	
*Derived from VA Rating Decision (VARD) dated 20060515 (most proximate to date of separation (DOS))

ANALYSIS SUMMARY:

Disruption of Posterior Cruciate Ligament (PCL) Condition.  A treatment note dated 29 September 2004 documented right knee pain and instability for a month after a right knee injury.  The CI was referred for a magnetic resonance imaging (MRI) study and physical therapy.  The MRI revealed a PCL tear.  The CI underwent a right knee PCL reconstruction on 31 March 2005.  The operative note documented restoration of firm posterior stability.  The CI underwent a post-operative course of physical therapy.  At an orthopedic evaluation 6 months after the surgery, the CI denied frank instability, but reported weakness “after walking and running a while.”  Testing for instability revealed mild instability with a firm PCL endpoint.  The examiner diagnosed an old disruption of PCL with symptomatic laxity.  The examiner opined that further reconstruction was not indicated and recommended a sedentary job.  The narrative summary examination dated 14 November 2005 documented reports of continued weakness and sensations of giving way of the right knee without frank instability.  The physical examination was significant right knee anterior and PCL instability.  There was no tenderness.  The examiner noted that the combination of anterior cruciate ligament and PCL laxity resulted in significant anteroposterior instability.  The examiner rendered a diagnosis of symptomatic right knee laxity.

At a VA internal medicine evaluation dated 15 February 2006, 2 months prior to separation, the CI reported right knee pain with weakness.  He reported constant pain rated 2 on a scale of one to 10.  He was unable to run.  Physical examination demonstrated evidence of limited and painful motion and laxity of the medial collateral ligament.  The examiner identified instability as having the major functional impact, but noted pain, incoordination and instability with repetitive use.  At the VA Compensation and Pension examination performed 12 months after separation, the CI reported right knee weakness, swelling, and giving out.  He reported constant burning pain rated 2/10.  The instability and pain prevented him from performing high impact activities, prolonged standing, and walking.

The Board directs attention to its rating recommendation based on the above evidence.  The PEB adjudicated the disruption of PCL treated with reconstruction, symptomatic right knee laxity as unfitting with a disability rating of 10%, coded 5262 (tibia and fibula impairment).  VA assigned a 10% rating for the right knee for instability, coded 5257 (knee impairment) and 10% for painful motion, coded 5260 (leg limitation of flexion).  The Board considered that evidence of instability and pain with use were evidenced in multiple treatment notes and VA examinations.  This case justifies Board consideration of separate ratings for instability and painful motion as established by formal VA policy in effect at the time of separation (General Counsel Opinion of 1 July 1997 and Fast Letter 04-22 of 1 October 2004).  By prior legal opinion and firm precedent, the Board adheres to this guidance.  After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the Board recommends a disability rating of 10% for the right knee laxity condition and IAW VASRD §4.59 (painful motion) 10% for right knee painful motion; a combined disability rating of 20%.

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 laxity condition, the Board unanimously recommends a disability rating of 10%, coded 5257  and 10% for painful motion, coded 5299-5260, for a combined rating of 20%,  IAW VASRD §4.71a and §4.59.  There were no other conditions within the Board’s scope of review for consideration.

RECOMMENDATION:  The Board recommends that the CI’s prior determination be modified as follows, effective as of the date of his prior medical separation:

UNFITTING CONDITION	VASRD CODE	RATING	
Right Knee Laxity	5257	10%	
Right Knee status post Posterior Cruciate Reconstruction	5299-5260	10%	
COMBINED	20%	
The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20140103, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans’ Affairs Treatment Record

		

MEMORANDUM FOR COMMANDER, NAVY PERSONNEL COMMAND
		   DEPUTY COMMANDANT, MANPOWER & RESERVE AFFAIRS
	                          
Subj:  PHYSICAL DISABILITY BOARD OF REVIEW (PDBR) RECOMMENDATIONS          

Ref:   (a) DoDI 6040.44
       (b) PDBR ltr dtd 14 Apr 15 ICO 
	 (c) PDBR ltr dtd 7 Apr 15 ICO 
	 (d) PDBR ltr dtd 14 Apr 15 ICO 
	 (e) PDBR ltr dtd 14 Apr 15 ICO 
       (f) PDBR ltr dtd 21 Apr 15 ICO 
                 
1.  Pursuant to reference (a) I approve the recommendations of the Physical Disability Board of Review set forth in references (b) through (f).

2.  The official records of the following individuals are to be corrected to reflect the stated disposition:

     a. former USN: Entitlement to disability severance pay with a disability rating of 20 percent (increased from 10 percent) effective date of discharge. 

     b. former USMC: Entitlement to disability severance pay with a disability rating of 20 percent (increased from 0 percent) effective date of discharge.

     c. former USMC: Entitlement to disability severance pay with a disability rating of 20 percent (increased from 10 percent) effective date of discharge.

     d. former USMC:  Entitlement to disability severance pay with a disability rating of 10 percent (increased from 0 percent) effective date of discharge. 

     e. former USN: Retroactive placement on the Temporary Disability Retired List with a disability rating of 50 percent for the 6 months immediately preceding discharge followed by disability separation effective date of discharge with a 10 percent disability rating. 

3.  Please ensure all necessary actions are taken to implement these decisions, including the recoupment of disability severance pay, if warranted, and notification to the subject members once those actions are completed.