RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXX	CASE:  PD-2014-03178
BRANCH OF SERVICE:  MARINE CORPS 	SEPARATION DATE:  20080929

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty LCpl/E-3 (Supply Admin Clerk) medically separated for left knee conditions, “unspecified orthopedic aftercare,” “old disruption of anterior cruciate ligament” and “chondromalacia,” rated at 10%. 

CI CONTENTION:  “Please consider all conditions”  

SCOPE OF REVIEW:  The Board’s scope of review is defined in DoDI 6040.44.  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 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:    

 IPEB – Dated 20080731	VA* - (~2 Mos. Pre-Separation) 	
Condition	Code	Rating	Condition	Code	Rating	Exam	
S/P L ACL Revision with…Chondromalacia…	5299-5003	10%	S/P Left Knee ACL Reconstruction	5260	10%	20080725	
			Scars, Left Knee	7804	10%	20080725	
Other x 0 (Not In Scope)	Other x 9	
RATING:  10%	RATING:  50%	
*Derived from VA Rating Decision (VARD) dated 20080930 (most proximate to date of separation [DOS]).  

ANALYSIS SUMMARY:  

Left Knee.  Prior to accession, the CI had bilateral reconstruction of the anterior cruciate ligament (ACL), a ligament which provides internal stability, as well as a repair of the left medial meniscus, a cartilage cushion inside the knee.  This was disclosed prior to accession and the CI received a waiver for enlistment based on the recommendation of his treating orthopedist.  The CI first presented with left knee pain on 23 January 2007, training day 13, and was treated conservatively with duty limitations, medications, and a (neoprene) knee sleeve.  He was able to complete basic training, but reinjured his knee on an obstacle course in early May 2007.  He was again treated conservatively, but his symptoms persisted and an MRI on 3 July 2007 showed a disruption of the previous left knee ACL repair.  This was again repaired surgically on 9 October 2007.  At the same time, the CI also had repair of the cartilage lining of the joint and debridement of the previously repaired medial meniscus.  The joint space was then free of all loose bone and cartilage.  Following surgery, the CI had rehabilitation in physical therapy (PT), but was not able to return to full duty and referred for Medical Evaluation Board (MEB).  The narrative summary (NARSUM) was dated 21 may 2007 and recorded that the CI had been on limited duty twice.  His post-operative progress was slow and his knee pain had worsened.  A knee brace reduced his symptoms, but he did not use it at work due to discomfort from it.  He stated that the knee buckled and swelled occasionally, but denied instability.  On examination, his gait was non-antalgic (not abnormal secondary to pain, implying normal).  His stance was normal and no effusion was present.  The knee was stable, but tender along the joint line.  The scars were well healed.  The range-of-motion (ROM) was reduced and painful.  At the VA Compensation and Pension (C&P) examination performed on 25 July 2008, 2 months before separation, the CI reported weakness, locking, and giving way.  On examination, his gait and posture were normal.  Signs of abnormal weight bearing were absent and no assistive device was used.  The ROM was normal, but painful.  With repetition, he reported increased pain, fatigue, weakness, and lack of endurance, but there was no further decrease in the ROM.  The knee was stable and signs of meniscal irritation absent.  The goniometric ROM evaluations in evidence which the Board weighed in arriving at its rating recommendation, with documentation of additional ratable criteria, are summarized in the chart below.

Left Knee ROM
(Degrees)	MEB ~4 Mo. Pre-Sep	PT ~7 Mo. Pre-Sep	VA C&P ~2 Mo. Pre-Sep	
Flexion (140 Normal)	135	135	140	
Extension (0 Normal)	0	0	0	
Comment	Painful motion	Limited by pain	Painful motion	
§4.71a Rating	10%	10%	10%	

The Board directed its attention to its rating recommendation based on the above evidence.  The PEB and VA both rated the knee at 10%, using the codes 5299-5003 (analogous to degenerative arthritis) and 5260 (limitation in flexion), respectively.  The Board considered the findings and that both the PEB and VA rated the left knee as a single condition.  While multiple diagnoses were present, assigning separate ratings for each is not permitted IAW VASRD §4.14 (avoidance of pyramiding).  Separate ratings are permitted for ratable limitations in motion and instability.  Ratable criteria are for instability, limitation in motion, effusions, locking, painful motion, and a frozen joint (ankylosis).  The knee was stable on multiple examinations.  The ROM limitation was non-compensable on the PT and MEB examinations and not present on the VA C&P.  An effusion was not documented and there was no meniscal fragment to account for the subjective locking which was recorded on the VA C&P, but not the NARSUM.  Painful motion supports the 10% rating adjudicated.  The joint was clearly not ankylosed.  The Board found no route to a rating higher than the 10% rating adjudicated by the PEB and VA.  There is no evidence in the record that the scar interfered with duty sufficiently to be separately unfitting.  After due deliberation in consideration of the preponderance of the evidence, the Board concluded that there was insufficient cause to recommend a change in the PEB fitness determination for the left knee condition.  

BOARD FINDINGS:  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.  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 20140617, 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 4 Feb 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
	Assistant General Counsel
	(Manpower & Reserve Affairs)