RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXXX	CASE:  PD-2014-02557
BRANCH OF SERVICE:  Marine Corps	BOARD DATE:  20150728
SEPARATION DATE:  20080830

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E-2 (Basic Marine) medically separated for a left knee anterior cruciate ligament (ACL–a ligament in the knee) tear.  This condition could not be adequately rehabilitated to continue with his follow-on training after boot camp, so he was placed in the Graduate Hold unit and referred for a Medical Evaluation Board (MEB).  Four conditions associated with the left knee (see rating comparison chart below) were forwarded to the Physical Evaluation Board (PEB) IAW SECNAVINST 1850.4E.  No other conditions except those depicted below were submitted by the MEB.  The Informal PEB adjudicated “left knee anterior cruciate ligament tear” as unfitting, rated 10%, with likely application of the Veterans Affairs Schedule for Rating Disabilities (VASRD).  The remaining conditions were determined to be Category II (contributing to the unfitting condition).  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:

PEB – Dated 20080714	VA*	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Left Knee ACL Tear	5299-5257	10%	Residuals…ACL Tear…	5299-5257	0%	Other**	
Left Knee Infected Seroma	Cat II	No VA Placement	
Surgical Treatment…	Cat II		
Left Medial Meniscal Tear	Cat II		
Other MEB/PEB Conditions x 0 (Not In Scope)	Other x 0	
RATING:  10%	RATING:  0%	
*Derived from VA Rating Decision (VARD) dated 20100413 (most proximate to date of separation [DOS])
**Based on unavailable private treatment records

ANALYSIS SUMMARY:

Left Knee Anterior Cruciate Ligament Tear.  The CI sustained a left knee injury during basic training in October 2007.  Arthroscopic surgery on 3 January 2008 repaired a torn ACL and medial meniscal tear; and a lateral meniscal tear was debrided.

Orthopedic follow-up on 21 March 2008 (5 months prior to separation) noted the knee to be non-tender.  The ACL was intact.  Knee flexion was 135 degrees (normal 140) and extension was 0 degrees (normal 0).  At an orthopedic re-evaluation on 16 May 2008 (3 months prior to separation) the CI reported development of a blister below the knee that was leaking fluid.  Examination showed full range of knee motion and an intact ACL.  The blister was determined to be a superficial infected seroma (post-operative fluid collection), which was surgically excised.

The MEB narrative summary on 23 June 2008 (2 months prior to separation) recorded a complaint of knee weakness and pain with exertion.  Symptoms of instability were not mentioned.  Examination showed left knee flexion of 140 degrees and extension of 0 degrees.  The ACL was intact and there was no joint tenderness or signs of infection.  Atrophy of the thigh muscle was present and the CI could not perform repetitive single-leg hops.  At the MEB exam, the CI reported that he used a knee brace when doing strengthening exercises.

The Board directed attention to its rating recommendation based on the above evidence.  In deliberating a rating recommendation, the Board considered that the CI’s disabling condition was pain.  Since there was no ACL instability (or any ligament instability) after surgery, code 5257 (Knee, other impairment of: recurrent subluxation or lateral instability) was a poor clinical fit.  Therefore, a compensable rating under this code was not supported.  While there was no evidence of compensable limitation of motion, a 10% rating was supported under code 5259 (Cartilage, semilunar, removal of, symptomatic); or alternatively under the 5003 coding pathway, given sufficient evidence of painful motion (§4.59).  Since frequent locking due to dislocated semilunar cartilage was not present, a 20% rating was not justified under code 5258.  The Board agreed that left knee infected seroma, surgical treatment of all of the above and left medial meniscal tear were properly subsumed under the unfitting condition.  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 rating for the left knee condition, but (even though the CI incurs no benefit) recommends a change in code to 5259.

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 left knee anterior cruciate ligament tear condition and IAW VASRD §4.71a, the Board unanimously recommends no change in the PEB rating, but a change in code to 5259.  There were no other conditions within the Board’s scope of review for consideration.

RECOMMENDATION:  The Board 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	
Left Knee Anterior Cruciate Ligament Tear	5259	10%	
COMBINED	10%	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20140514, 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 30 Nov 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:

- XXXXXXXXXXXXXXXXXXXX, former USMC  
- XXXXXXXXXXXXXXXXXXXX, former USMC 
- XXXXXXXXXXXXXXXXXXXX, former USMC
- XXXXXXXXXXXXXXXXXXXX, former USMC
- XXXXXXXXXXXXXXXXXXXX, former USMC
- XXXXXXXXXXXXXXXXXXXX, former USMC
- XXXXXXXXXXXXXXXXXXXX, former USMC
- XXXXXXXXXXXXXXXXXXXX, former USMC
- XXXXXXXXXXXXXXXXXXXX, former USMC
- XXXXXXXXXXXXXXXXXXXX, former USMC

						  XXXXXXXXXXXXXXXXXXXX
	     				  Assistant General Counsel
						  (Manpower & Reserve Affairs)