RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXXX	CASE:  PD-2014-02859
BRANCH OF SERVICE:  MARINE CORPS	BOARD DATE:  20141029
SEPARATION DATE:  20030830

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E-3 (Field Radio Operator) medically separated for left knee pain.  The 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 and referred for a Medical Evaluation Board (MEB).  The left knee condition, characterized as “left knee pain status post arthroscopic lateral release for excessive lateral pressure syndrome of the patella” was forwarded to the Physical Evaluation Board (PEB) IAW SECNAVINST 1850.4E.  The MEB also identified and forwarded one other condition (limitation of motion status post arthroscopy of the left knee) for PEB adjudication.  The Informal PEB adjudicated the left knee pain condition as unfitting, rated 10%, with application of the Veterans Affairs Schedule for Rating Disabilities (VASRD).  The remaining condition was determined to be category II (contributing to unfit condition).  The CI made no appeals and was medically separated.

CI CONTENTION:  “Please consider all condition.”

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 20030417	VA* – (~4 Mos. Pre-Separation)	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Left Knee Pain 	5299-5003	10%	Residuals, Miniscectomy and Arthroscopic Lateral Release, Left Knee	5262	10%	20030516	
Left Knee Limitation of Motion	Cat II					
Other x 0  (Not in Scope)	Other x 2	
Rating: 10%	Combined:  20%	
*Derived from VA Rating Decision (VARD) dated 20030910 (most proximate to date of separation (DOS)).
ANALYSIS SUMMARY:  The Board unanimously agreed that the left knee limitation of motion condition was associated to the left knee pain condition, and considered both together.

Left Knee Pain and Limitation of Motion:  The narrative summary (NARSUM) notes the CI to have a past history, prior to enlistment, of arthroscopic surgery in 1992 for repair of a torn meniscus in the left knee.  This healed without difficulty and he enlisted and entered active duty without knee complaint or findings of knee derangement on entrance physical exam.  The left knee pain appeared in October 2001 during training for deployment in Operation Enduring Freedom.  A magnetic resonance imaging (MRI) of the knee performed on 6 June 2002, revealed no evidence of internal derangement of bone or ligaments but slight misalignment of the knee cap with tilting.  Arthroscopic surgery was performed on 12 July 2002 and the scar tissue holding the knee cap in the inappropriate position was cut returning the knee cap to its proper position in the knee joint.  Post-operatively, the CI had continued knee pain.  On orthopedic evaluation performed on 19 November 2002, 4 months post-operatively and recorded in the chart below, the knee was found to be stable with reduced range-of-motion (ROM).  On physical therapy (PT) evaluation performed on 9 January 2003, a month prior to the NARSUM evaluation, knee evaluation was unchanged as recorded in the chart below.  At the MEB/NARSUM evaluation performed on 26 February 2003, 6 months prior to separation, the CI reported continued pain in the left knee below the knee cap.  The MEB physical exam findings are recorded in the chart below.

At the VA Compensation and Pension (C&P) exam performed 16 May 2003, 4 months prior to separation, the CI reported the knee to be ‘quite unstable’ and to ‘buckle’ if he is not wearing a knee brace which ‘he does most of time; but the exam recorded no history of ‘locking’.  Findings on physical examination are in the chart below.

The goniometric ROM evaluations in evidence which the Board weighed in arriving at its rating recommendation, with documentation of additional ratable criteria, are summarized:

Left Knee ROM
(Degrees)	Ortho ~ 10 Mo. Pre-Sep	
MEB ~ 6 Mo. Pre-Sep
	
PT ~5 Mo. Pre-Sep
	
VA C&P ~ 4 Mo. Pre-Sep
	
Flexion 
(140 Normal)	125	120 with pain	118 with pain	110 with pain	
Extension 
(0 Normal)	0	0	0	0	
Comment	Healed scars; no instability	Incisions healed; no effusion/ instability; normal patellar tracking without tilt	Pain on motion; no instability or effusion.
	No instability or swelling; gait and stance wnl; wears knee brace/removed during exam.; no DELUCA; knee x-rays wnl	

On PT evaluation at the VA performed on 20 April 2004, there was no report of knee instability.  On PT evaluation dated 7 May 2004, 9 months after separation, MRI of the knee was reported as negative.  On exam, ROM was reported as 110 degrees with some lateral knee cap instability.  Gait was recorded as normal.  No surgery was recommended and the CI declined surgical follow-up.  The CI was discharged from the VA for further knee care on 30 July 2004.

The Board directed attention to its rating recommendation based on the above evidence.  The PEB and VA both rated the knee pain condition 10% using different codes; the PEB, coded 5299-5003 (analogous to arthritis), and the VA, coded 5262 (impairment of tibia/slight).  The next higher rating higher of 20% under this code requires the knee condition to be “moderate” in severity, which was not supported by the record in evidence.  The Board unanimously agreed the knee condition rose to the level of 10%, but no more, for painful motion IAW §4.40.  The Board also agreed the record in evidence did not support a rating under codes 5260 (limitation of flexion) or 5261 (limitation of extension), and that no rating higher than 10% was supported under code 5262 (knee impairment) as the Board unanimously agreed the knee condition was not of “moderate severity.”  The Board agreed that no rating could be recommended under code 5258 (cartilage dislocated) as the record recorded no “frequent episodes, of locking or effusion of the knee.”  The Board considered a rating under code 5257 (knee instability) and noted the reports by the CI of ‘severe knee instability’ and the knee “giving way” in the C&P evaluation of 16 May 2003, but none other.  The Board agreed that these reports were subjective as there were no clinical findings of knee instability on this or other proximate examinations.  The Board further noted the clinical findings of patellar instability on a VA examination 9 months after separation, but not present on VA examination 2 months prior.  The Board acknowledged that, after separation from the military, some patellar instability developed, but this was not supported by the record in evidence as being present at the time of separation.  The Board unanimously agreed it could recommend no rating under code 5257 and members found no other appropriate codes for rating consideration.  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:  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 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 20140513, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

		
XXXXXXXXXXXXXXXXXXXX
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) RECOMMENDATION 
Ref:	(a) DoDI 6040.44
(b) CORB ltr dtd 25 Jun 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 USN
-	XXXXXXXXXXXXXXXXXXXX, former USN
-	XXXXXXXXXXXXXXXXXXXX , former USN
-	XXXXXXXXXXXXXXXXXXXX, former USN
-	XXXXXXXXXXXXXXXXXXXX, former USMC
-	XXXXXXXXXXXXXXXXXXXX, former USN
-	XXXXXXXXXXXXXXXXXXXX, former USN
-	XXXXXXXXXXXXXXXXXXXX, former USN
-	XXXXXXXXXXXXXXXXXXXX, former USMC
-	XXXXXXXXXXXXXXXXXXXX, former USN
-	XXXXXXXXXXXXXXXXXXXX, former USMC
-	XXXXXXXXXXXXXXXXXXXX, former USMC
-	XXXXXXXXXXXXXXXXXXXX, former USN

XXXXXXXXXXXXXXXXXXXX
Assistant General Counsel (Manpower & Reserve Affairs)