RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2014-01189
BRANCH OF SERVICE:  MARINE corps	SEPARATION DATE:  20071130  

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E-4, Administrative Clerk, medically separated for “right knee osteoarthritis secondary to right tibial plateau fracture,” with a disability rating of 20%. 

CI CONTENTION:  The applicant makes no specific contention in her application.  Her 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 - 20070917	VARD - 20080310	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Right Knee Osteoarthritis Secondary to Right Tibial Plateau Fracture	5255	20%	Right Knee Patellofemoral Pain Syndrome, Chondromalacia and Degenerative Arthritis Status Post Tibial Plateau Fracture	5010-5262	30%	20070910	
Malunion of Right Proximal Tibial Plateau Fracture Healed Status Post ORIF Allograft	Cat II					
COMBINED RATING:  20%	COMBINED RATING OF ALL VA CONDITIONS:  40%	

ANALYSIS SUMMARY:  

Right Knee Osteoarthritis Secondary to Right Tibial Plateau Fracture.  The service treatment record (STR) and narrative summary (NARSUM) documented a motor vehicle accident in February 2004 (4 years pre-separation) that resulted in bilateral knee (tibial plateau) fractures.  Several surgeries (right external fixation; right open reduction with internal fixation; and right hardware removal; left reduction and internal fixation) were performed in February 2004.  In March 2005, bilateral knee hardware was removed due to pain.  Radiographic imaging was obtained in November 2005 (2 years pre-separation) for persistent right knee pain, and documented a lateral meniscal tear and a torn lateral collateral ligament, with intact cruciate and medial collateral ligaments.  Radiographic evaluation in March 2006 (20 months pre-separation) documented right knee osteopenia, healing tibial plateau fracture, near normal anatomic alignment, and no joint effusion.  Right knee arthroscopy was performed in September 2006 (14 months pre-separation) for debridement and chondroplasty of the left lateral compartment.  No meniscal tears were seen; and both collateral ligaments were intact.  At a follow-up visit, 2 weeks post arthroscopy, the examiner documented tenderness over the medial joint line with a range-of-motion (ROM) of 0-130 degrees (normal 0-140), and no swelling.  

A Medical Evaluation Board (MEB) in April 2007 (7 months pre-separation) found the CI fit for duty.  At an orthopedic visit in April 2007 the CI reported 2/10 medial knee pain, increased with activity and climbing stairs, with occasional instability, and denied locking.  The examiner documented crepitus; tenderness of the lateral joint line and lateral and medial knee (lateral tibial plateau and medial condyle); no varus or valgus laxity; and normal strength and sensation.  Traumatic arthritis was diagnosed and another surgery (hemicondyle replacement with meniscus allograft) was performed the next day.  On follow-up a week later, the examiner documented a ROM of 0-100 degrees, with no edema, normal strength, and decreased sensation lateral to the incision.  On the MEB DD Form 2807-1, Report of Medical History, dated 12 April 2007 (7 months pre-separation), the CI reported wear of a knee brace.  On an MEB addendum in June 2007 (5 months pre-separation), the examiner documented a range-of-motion of 0-130 degrees and opined that, despite multiple interventions, the CI was not qualified to remain on active duty.  Radiographic studies in July 2007 (4 months pre-separation) reportedly documented a healed fracture.  

The MEB NARSUM examination was performed on 7 August 2007 (4 months pre-separation).  The CI reported improvement in activity, with the ability to walk, bear full weight, and perform activities of daily living.  The examiner documented painless crepitus with a ROM of 0-135 degrees.  There was tenderness along the lateral tibial plateau with no joint line tenderness; no laxity or instability; and normal strength and sensation.  The examiner diagnosed “malunion of right proximal tibial plateau fracture,” with subsequent “right knee osteoarthritis.”  At a neurology visit for electrophysiologic studies in September 2007 (3 months pre-separation), the CI reported right ankle pain and swelling with numbness of the lateral calf and ankle.  The examiner documented a normal study.  

At the VA Compensation and Pension (C&P) examination dated 10 September 2007 (3 months pre-separation), the CI reported 5/10 pain that increased to 8/10 with walking and standing; difficulty climbing stairs; occasional giving way and locking without falling; intermittent swelling; and inability to kneel or squat.  She denied use of assistive devices.  The examiner documented “minimal” effusion and “minimal” limp.  There was crepitation and tenderness of the medial and lateral joint lines and with patellar compression.  R	OM was 0-140 degrees with pain, and no additional limitations were noted on repetition.  The CI was able to squat “75% with pain.”  Bilateral laxity of the anterior cruciate ligament was noted with all other ligaments intact.  

The Board directed attention to the rating recommendation based on the above evidence.  The PEB adjudicated the “right knee osteoarthritis secondary to right tibial plateau fracture” as unfitting, and designated the “malunion of right proximal tibial plateau fracture, healed…” as a category II condition.  It was rated 20% and coded 5255 (femur, malunion of, with moderate knee disability).  The VA rated the “right knee patellofemoral pain syndrome, chondromalacia, and degenerative arthritis status post tibial plateau fracture” at 30%, coded analogously as 5010-5262 (tibia, impairment of, malunion with marked knee disability).  
The Board considered the evidence for a rating higher than 20%.  There was no evidence of ankylosis (5256) or recurrent severe subluxation or lateral instability (5257) for a higher rating.  There was no documentation of flexion limited to 15 degrees (5260) or extension limited to 20 degrees (5261) in support of a higher rating.  It was noted that the PEB coded under 5255, however there was no evidence of impairment or malunion of the femur.  As done by the VA, a more appropriate code would have been an analogous code 5010-5262 for tibial malunion.  At the time of separation, the CI was able to nearly fully flex and fully extend the knee, inconsistent with a marked disability (for a higher rating of 30%).  Four months pre-separation, the CI reported a nearly fully functional knee (with the ability to walk, bear full weight, and perform the activities of daily living) and there was documentation of a near normal examination.  Three months pre-separation, the CI reported slight to moderate knee disability (with pain on walking and standing, difficulty climbing stairs, occasional giving way and locking without falling, and inability to fully kneel or squat) while the examiner documented a pain-limited squat, full range-of-motion with pain, and no additional limitations on repetition.  This description more nearly approximated a “slight” to “moderate” knee disability, rather than a “marked” disability, and would not support a higher rating under the 5262 code.  

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 adjudication for the right knee condition.  

BOARD FINDINGS:  In the matter of the right 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. 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 20140307, 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 16 Mar 16

      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 USMC 
	- XXXXXXXXXXXXXXXXXXXX, former USMC
	- XXXXXXXXXXXXXXXXXXXX, former USMC