RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXXX	CASE:  PD-2014-01679
BRANCH OF SERVICE:  Marine Corps 	SEPARATION DATE:  20090530

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty, E2, Rifleman, medically separated for “left lateral meniscal tear status post (S/P) with subsequent failed healing and resection and subsequent lateral meniscal transplantation,” with a disability rating of 10%.  

CI CONTENTION:  The CI elaborated 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 - 20090530	VARD - 20120622	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Left Lateral Meniscal Tear…	5099-5003	10%	Left Lateral Meniscal Tear	5257	0%	20120622	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  0%	

ANALYSIS SUMMARY:  

Left Lateral Meniscal Tear….  According to service treatment records (STR’s) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI underwent a left knee lateral meniscal repair in December 2006, a total lateral menisectomy in August 2007 and a left knee lateral meniscal transplantation in June 2008.  The radiograph (X-ray) done in July 2008 showed loose bony fragments in the anterior tibiofemoral joint with a suprapatellar joint effusion.  There was a “question the possibility” of anterior cruciate ligament (ACL) injury, and suspicious thickening of the pre-patellar and anterior infrapatellar soft tissues.  

At the MEB NARSUM examination dated 7 January 2009, approximately 5 months prior to separation, the CI reported daily left knee shooting, aching, sharp, pinching pain rated at 7/10 which increased to 9/10 with strenuous activities.  The examiner noted functional limitations of an inability to run, jump, climb, squat, march, hump, do unit PT, PFT, sports, martial arts, field duty, rifle range, working parties, standing watch and formations.  

At the VA Compensation and Pension (C&P) examination in June 2012, performed approximately 3 years after separation, the CI reported chronic throbbing left knee pain which was worse in cold and rainy weather; and sharp, stabbing pain in the center of the knee with rolling inversion and stepping off balance.  

The Board directed attention to its rating recommendation based on the above evidence.  The PEB assigned a 10% rating under an analogous 5003 code (arthritis, degenerative).  The VA assigned a 0% rating using the 5257 code (knee, other impairment of:  recurrent subluxation or lateral instability) based on the VA C&P examination approximately 3 years after separation, citing a diagnosed disability with compensable symptoms.  

There was no limitation of motion which supported a rating under the diagnostic codes for limitation of flexion or extension (5260, 5261).  However, there was evidence of painful motion with functional loss supporting a 10% rating (based on §4.59, §4.40 and §4.45) as adjudicated by the PEB.  The 5259 code (cartilage, semilunar, removal of, symptomatic) was applicable in this case but the maximum 10% rating under that code provided no benefit to the CI.  There was not sufficient evidence of frequent episodes of “locking,” pain, and effusion into the joint for analogous coding under 5258 (cartilage, semilunar, dislocated …).  The examinations proximate to separation did not demonstrate the presence of ligamentous instability or laxity (5257), for any higher rating under code 5257.  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).  No additional functional limitation was evidenced by the examinations.  There is therefore no VASRD §4.71a route to a rating higher than the 10% adjudicated by the PEB under any applicable code, and no grounds for additional rating based on the presence of instability.  

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 left knee condition.  

BOARD FINDINGS:  In the matter of the left lateral meniscal tear 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 20140414, 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 9 May 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:

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