RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXX	CASE:  PD-2014-01962
BRANCH OF SERVICE:  MARINE CORPS	BOARD DATE:  20141231
SEPARATION DATE:  20060331

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E-3 (Mortarman) medically separated for a right knee condition.  The condition could not be adequately rehabilitated to meet the physical requirements of his Military Occupational Specialty.  He was placed on limited duty and referred for a Medical Evaluation Board (MEB).  The right knee condition, characterized as “sprain and strain of cruciate ligament of knee” was forwarded to the Physical Evaluation Board (PEB) IAW SECNAVINST 1850.4E.  No other conditions were submitted by the MEB.  The Informal PEB adjudicated “right anterior cruciate ligament deficient knee” as unfitting, rated 10% with likely application of the VA Schedule for Rating Disabilities (VASRD).  The CI made no appeals at that time and was medically separated.

CI CONTENTION:  “Please consider all conditions.”

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 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 IPEB – Dated 20060125	VA – (60 mos. Post-Separation)  	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Right Anterior Cruciate Ligament Deficient Knee	5262	10%	Right Knee, S/P Cruciate Ligament Reconstruction	5010-5260	10%	20110407	
Other x 0 (Not In Scope)	Other x 1	
Combined:  10%	Combined:  20%	
Derived from VA Rating Decision (VARD) dated 20110824 (only available VARD, which was no change from Original VARD)

ANALYSIS SUMMARY:

Right Knee Condition.  In August 2004, this Marine injured his right knee during a training event.  He underwent surgery to repair a fracture of the tibial tubercle.  After surgery, the fracture healed.  However, he continued to have some knee instability.  Physical examination (PE) of the right knee revealed deficiency of the anterior cruciate ligament (ACL).  The CI was offered surgery to reconstruct the ACL, but he declined.  Due to the chronic, persistent nature of the knee symptoms, an MEB was initiated.  The MEB physical exam was on 29 August 2005.  At that time, the CI reported occasional pain in the right knee.  The most prominent symptom was a feeling of instability whenever he would change direction or climb stairs.  On PE of the right knee, there was no tenderness to palpation anteriorly.  The knee was stable to varus/valgus stress and range-of-motion (ROM) was 0 to 130 degrees.  Lachman’s sign was 2+, with positive pivot shift (indicating ACL deficiency).  Posterior drawer was negative.

The CI separated from service on 31 March 2006.  On 7 April 2011, 5 years later, he had a VA Compensation and Pension exam.  The CI reported pain, stiffness, and instability of the right knee, but he denied any impact on his job or his daily activities.  PE of the right knee revealed no edema, but there was some tenderness and post-patellar effusion.  There was no instability, redness, heat, abnormal movement, guarding of movement, deformity, mal-alignment, drainage or weakness.  Gait was normal.  ROM was 0 to 140 degrees, and repetitive motion did not produce any decrease in ROM.  McMurray’s test was negative, and there was no lateral motion with varus/valgus stress.  There was no evidence of pain with knee ROM.  The ROM evaluations, which the Board weighed in arriving at its rating recommendation, are summarized in the chart below.

Right Knee ROM
(Degrees)	MEB ~7 mos. Pre-Sep
(20050829)	C&P ~60 mos. Post-Sep
(20110407)	
Flexion (140 Normal)	130	140	
Extension (0 Normal)	0	0	
§4.71a Rating	10%*	10%*	
*10% rating not based on ROM, but on other factors

The Board carefully examined all available evidence and directed attention to its rating recommendation.  The Navy PEB and the VA chose different coding options for the right knee condition, but both assigned a disability rating of 10%.  The August 2005 MEB exam was just 7 months prior to separation and therefore had significant probative value.  At that exam, the most prominent symptom was a feeling of instability of the knee whenever he would change direction or climb stairs.  PE of the right knee revealed ROM of 0 to 130 degrees.  Lachman’s sign was 2+, with positive pivot shift (indicating ACL deficiency).

The Board determined that, at the time of separation, the CI’s knee disability was best described as “slight.”  There was insufficient evidence in the record to support a “moderate” or “marked” disability of the right knee.  IAW the VASRD §4.71a, a rating of 10% is appropriate when there is objective evidence of slight knee disability or impairment.  The Board tried to find a path to a rating higher than 10% for the knee condition, but there was not sufficient evidence of a significantly disabling joint abnormality that would justify a higher rating.  After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the Board found insufficient cause to recommend a change in the PEB adjudication for the right knee condition.

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.  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 20140417, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans’ Affairs Treatment Record

				
XXXXXXXXXXXXXXX
President
DoD Physical Disability Board of Review

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 18 May 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 USN
- XXXXXXXXXXXXXXX, former USN
- XXXXXXXXXXXXXXX, former USMC
- XXXXXXXXXXXXXXX, former USMC
- XXXXXXXXXXXXXXX, former USMC
- XXXXXXXXXXXXXXX, former USMC
- XXXXXXXXXXXXXXX, former USMC

		  XXXXXXXXXXXXXXX
		  Assistant General Counsel
		  (Manpower & Reserve Affairs)