RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2014-00386
BRANCH OF SERVICE:  Marine Corps 	SEPARATION DATE:  20060215

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty, E2, Infantry, medically separated for “status post right knee ACL reconstruction with medial meniscal tear and lateral meniscal debridement a right knee condition” with a disability rating of 0%.

CI CONTENTION:  The CI made no specific contention in his application.  The CI’s complete submission is at Exhibit A.  

SCOPE OF REVIEW:  The Board’s scope of review is defined in DoDI 6040.44.  It is limited to those conditions determined by the Physical Evaluation Board (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 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 Veterans Affairs Schedule for Rating Disabilities (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:  

SERVICE PEB – 20051223	VARD - 20060424	
Condition	Code	Rating	Condition	Code	Rating	Exam	
S/P Right Knee ACL…	5299-5257	0%	Right Knee Flexion	5260	10%	20051212	
			Right Knee Tear ACL & Tears of Medial & Lateral Menesci…	5261	10%	20051212	
COMBINED RATING:  0%	COMBINED RATING FOR ALL VA CONDITIONS:  20%	

ANALYSIS SUMMARY:

Right Knee.  According to service treatment records and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI underwent right knee arthroscopic surgery on 5 October 2005 (4 months prior to separation) after sustaining two knee injuries in July and August 2005 during recruit training.  Given the expected length of recovery from this procedure and his training status, the CI was referred for an MEB.  The MEB forwarded “status post right knee anterior cruciate ligament reconstruction with medial meniscal tear and lateral meniscal debridement” for PEB adjudication.
The MEB NARSUM examiner on 3 November 2005 (a month after surgery and 3 months prior to separation) reported that the CI had no complaints and should expect limited activities for another 6-8 months.  Examination showed use of a knee ROM brace and crutches.  There was minimal right knee swelling and no joint line tenderness.  Tests for instability were negative, and included two tests for anterior cruciate ligament (ACL) integrity.  One test for possible meniscal injury was negative.   

At an orthopedic clinic appointment on 1 December 2005 (2 months after surgery and 2 months prior to separation), the CI complained of constant right knee pain (3/10 severity) that was aggravated after prolonged walking.  Examination showed mild swelling and mild joint line tenderness of the right knee.  There was no ligament instability present, and there was no evidence of painful ambulation.  

At the VA Compensation and Pension (C&P) evaluation on 12 December 2005, the examiner confirmed that symptoms of knee instability resolved after surgery.  Physical exam showed that the CI was “in mild distress with pain and limp of the right leg.”  There was no right knee swelling, but joint line tenderness and patellar crepitation were present.  All tests for instability were negative, and a test for possible meniscal injury was negative.  Repetitive ROM testing showed no additional loss of joint function because of pain, fatigue, weakness, lack of endurance, or incoordination (DeLuca factors).    

The Board directed attention to its rating recommendation based on the above evidence.  The PEB rated the right knee condition 0% analogously coded to 5257 (knee, other impairment of:  recurrent subluxation or lateral instability).  Although the VA rating decision specified that separate evaluations based on limitation of motion were not warranted, dual rating for the right knee was nevertheless assigned under disability codes 5260 (limitation of flexion) at 10% and 5261 (limitation of extension) at 10%.  The Board agreed that dual rating was not warranted in this case, since there was no appropriate combination of limitation of motion, painful motion or instability.  Although a 10% rating for limitation of extension based on the C&P exam was questionable (8 degrees of limited extension approached, but did not achieve, the 10 degree threshold in the context of pre-separation measurements of 5 degrees), other routes to 10% were present.  For example, the CI underwent meniscal surgery that fulfilled the “removal of, symptomatic” (of semilunar cartilage) stipulation of the 5259 code.  Likewise, Board members concluded that a 10% rating IAW functional loss (§4.40) or painful motion (§4.59) was reasonably conceded in this case.  In considering routes to a higher rating, it was agreed that the absence of ligamentous instability or laxity rendered the 5257 code a poor choice, and there was no history of dislocated meniscus or loose body causing frequent locking with recurrent effusions for consideration of the 5258 code.  Finally, there was no fracture, non-union or malunion of the femur or tibia to support consideration under the respective codes for knee impairment related to long bone conditions (5255, 5262).  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 condition, coded 5259.  

BOARD FINDINGS:  In the matter of the right knee condition, the Board unanimously recommends a disability rating of 10%, coded 5259 IAW VASRD §4.71a.  There were no other conditions within the Board’s scope of review for consideration. The Board, therefore, recommends that the CI’s prior determination be modified as follows, effective as of the date of his prior medical separation:  

CONDITION	VASRD CODE	RATING	
Status Post Right Knee Ligament Reconstruction and Meniscal Debridement	5259	10%	
COMBINED	10%	

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 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 11 Mar 16 ICO XXXXXXXXXXXXXXX
	(c) PDBR ltr dtd 2 Mar 16 ICO XXXXXXXXXXXXXXX
	(d) PDBR ltr dtd 14 Mar 16 ICO XXXXXXXXXXXXXXX
	(e) PDBR ltr dtd 14 Mar 16 ICO XXXXXXXXXXXXXXX
	(f) PDBR ltr dtd 14 Mar 16 ICO XXXXXXXXXXXXXXX
	(g) PDBR ltr dtd 14 Mar 16 ICO XXXXXXXXXXXXXXX

1.  Pursuant to reference (a), the recommendations of the Physical Disability Board of Review set forth in references (b) through (g) are approved.

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

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

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

     c. XXXXXXXXXXXXXXX, former USMC: Assignment to the Temporary Disability Retired List for six months effective date of discharge with a 50 percent disability rating followed by transfer to the Permanent Disability Retired List with a final disability rating of 30 percent.

     d. XXXXXXXXXXXXXXX, former USMC: Entitlement to disability separation pay with a 20 percent disability rating (increased from 10 percent) effective date of discharge.

     e. XXXXXXXXXXXXXXX, former USN: Placement on the Permanent Disability Retired List with a 30 percent disability rating effective date of discharge.

     f. XXXXXXXXXXXXXXX, former USMC: Assignment to the Temporary Disability Retired List for six months effective date of discharge with a 50 percent disability rating followed by transfer to the Permanent Disability Retired List with a final disability rating of 50 percent. 

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 complete.