RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXXX	CASE: PD-2014-02080
BRANCH OF SERVICE:  MARINE CORPS	BOARD DATE:  20150325
Separation Date:  20030430

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E-4 (Bulk Storage) medically separated for a right knee condition.  The right knee 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 (LIMDU) and referred for a Medical Evaluation Board (MEB).  The right knee condition, characterized as by the MEB as “right knee advance degenerative joint disease (DJD)” 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 knee advanced DJD” as unfitting, rated 10%, with likely application of the Veterans Affairs Schedule for Rating Disabilities (VASRD).  The CI made no appeals 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 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 20030213	VA - (<1 Mos. Pre-Separation)	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Right Knee Advanced DJD	5299-5003	10%	Residuals, Post-Operative Right Knee with DJD	5003-5259	10%	20030314	
Other x 0	Other x 8	
Rating:  10%	Combined:  40%	
Derived from VA Rating Decision (VARD) dated 20030505 (most proximate to date of separation [DOS])

ANALYSIS SUMMARY:

Right Knee Advanced DJD Condition.  The CI injured his right knee during physical training in November 2000.  He was seen in a medical clinic for a 3-month history of right knee sharp throbbing pain with running, jumping or sitting for prolonged periods of time.  There were physical exam findings of full range-of-motion (ROM) and normal strength.  The examiner diagnosed patellofemoral syndrome of the right knee and ordered a non-steroidal anti-inflammatory drug and strengthening/stretching exercises.  The right knee X-ray showed an osteochrondral bone fragment in the anterior compartment of the knee.  A magnetic resonance imaging (MRI) showed a lateral handle bucket tear, osteochondritis dessicans of the lateral femoral condyle and an 8mm loose body.  In March 2002, an orthopedist noted right knee pain and locking with full ROM and recommended arthroscopy.  The medical provider based on the MRI findings and physical findings of chronic right knee pain and a positive McMurray sign recommended an 8-month LIMDU and an orthopedic follow-up.  The CI underwent a right knee partial lateral menisectomy, loose body removal and chondroplasty with drilling on 29 April 2002.  The medical provider noted no improvement in the right knee pain after surgery; and an inability to run.  There were physical exam findings of ROM limited to 130 degrees with pain at endpoints; and medial and lateral joint line pain.  The examiner diagnosed right knee lateral DJD.  The MEB narrative summary exam performed approximately 2 months prior to separation documented the CI continued to complain of right knee pain even with normal weight bearing despite surgery and maximum medical therapy.  He opined that the CI’s medical condition precluded him from continuing in full duty status.  The VA Compensation and Pension (C&P) exam performed 3 weeks after separation documented the CI’s right knee pain symptoms had worsened since his arthroscopy.  The VA C&P physical exam findings are summarized in the chart below.

There were ROM evaluations in evidence, with documentation of additional ratable criteria, which the Board weighed in arriving at its rating recommendation; as summarized in the chart below.

Right Knee ROM (Degrees)	MEB 2 Mo. Pre-Sep	VA C&P 3 weeks Pre-Sep	
Flexion (140 Normal)	130	105	
Extension (0 Normal)	0	0	
Comment	Pos. painful motion; No effusion or instability; Pos. tenderness to palpation; Neurovascular intact lower leg	Normal gait; Pos. painful motion, mild swelling, & crepitus; No instability; Pos. Deluca criteria; Normal strength, sensation & reflexes	
§4.71a Rating	10%* (PEB 10%)	10%* (VA 10%)	
*IAW VASRD §4.59, Painful Motion

The Board directed attention to its rating recommendation based on the above evidence.  The PEB coded the right knee DJD condition as 5299 analogous to 5003 (Arthritis, degenerative hypertrophic or osteoarthritis) and rated at 10%.  The VA coded the residuals, post-operative right knee with DJD condition as 5003 (degenerative arthritis), with 5259 (symptomatic removal of the semilunar cartilage) and rated at 10%.  All evidence proximate to separation documented pain with activity and with ROM.  VASRD §4.71a specifies for 5003 that application of a 10% rating “for each such major joint or group of minor joints affected by limitation of motion” and VASRD §4.59 painful motion provides an alternate justification for a 10% rating.  The Board considered using the coding schema of 5257 (other impairments of the knee); however, there was no evidence of recurrent subluxation or lateral instability as required for that code.  The right knee condition could not be reasonably rated higher than 10% using any exam proximate to separation or any alternate rating schema.  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:  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 20140507, 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 20 Aug 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 USMC
- XXXXXXXXXXXXXXX, former USN
- XXXXXXXXXXXXXXX, former USMC
- XXXXXXXXXXXXXXX, former USMC
- XXXXXXXXXXXXXXX, former USN
- XXXXXXXXXXXXXXX, former USMC
- XXXXXXXXXXXXXXX, former USN
- XXXXXXXXXXXXXXX, former USN
- XXXXXXXXXXXXXXX, former USMC
- XXXXXXXXXXXXXXX, former USMC
- XXXXXXXXXXXXXXX, former USN
- XXXXXXXXXXXXXXX, former USN