RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXXX	CASE:  PD-2014-03476
BRANCH OF SERVICE:  Marine Corps 	SEPARATION DATE:  20081230

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E4, Personnel Clerk, medically separated for “chronic knee pain,” with a disability rating of 10%.  

CI CONTENTION:  His condition continues to worsen and negatively impact his daily activities.  The CI’s complete submission is at Exhibit A.  

SCOPE OF REVIEW:  The Board’s scope of review is defined in DoDI 6040.44.  It is limited to those conditions determined by the Physical Evaluation Board (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 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 based on 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 PEB – 20080825	VARD – 20090102	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Knee Pain 	5299-5003	10%	Osteochondritis Dissecans, Medial Femoral Condyle, Left Knee	5260-5019	10%*	20080904	
Osteochondritis Dissecans of Medial Femoral Condyle	Cat II					
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  50%	
*0% increased to 10% on 20090923 VA Decision Review Officer Decision, retroactive to separation.

ANALYSIS SUMMARY:

Chronic Knee Pain (Left).  According to the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s left knee pain began in July 2006 during a battalion formation run.  The NARSUM referenced magnetic resonance imaging on 4 April 2007, which indicated an area of chondral injury; a follow-on CT [computed tomography] scan on 27 March 2008 showed evidence osteochondritis dissecans.  Surgery was not indicated and conservative treatment did not result in improvement sufficient to allow unrestricted duty. The MEB forwarded “osteochondritis dissecans” and “pain in joint involving lower leg” for PEB adjudication.  At the MEB NARSUM examination on 11 June 2008, (7 months before separation) the CI reported pain that was localized deep to the medial joint line.  It was aggravated by extended walking, running, and standing.  The physical examination showed no joint effusion or tenderness and “normal range of motion.”  The knee was stable and without evidence of meniscal injury.  

During the VA Compensation and Pension (C&P) examination on 4 September 2008 (5 months before separation), the CI reported weakness and stiffness, giving way, locking and lack of endurance.  On examination, the knee was not tender on palpation, but there was crepitus.  The range of motion was full and pain-free.  The knee was stable and without signs of meniscal irritation.  

The Board directed attention to its rating recommendation based on the above evidence.  The PEB assigned a 10% rating under the analogous code 5299-5003 (arthritis, degenerative).  The Navy PEB also listed osteochondritis dissecans of medial femoral condyle as a related Category II condition (a condition that contributed to the primary unfitting condition but was not separately ratable).  The impairment from the osteochondritis dissecans was properly subsumed under the overall rating for the chronic knee pain condition IAW §4.14 (avoidance of pyramiding; more than one rating based on the same impairment is prohibited).  The VA initially rated the knee at 0%, coded 5260-5019 (limitation of flexion of the leg-bursitis).  However, it was increased to 10%, retroactive to separation, based on a de novo review of the evidence by a decision review officer (DRO), citing painful motion.  The Board considered the evidence and noted the presence of crepitus.  Although not specifically noted on examination, the Board agreed that pain with motion was implied in the history of the knee condition and that a rating of 10% is supported IAW VASRD §4.59 (painful motion).  There was no limitation in motion, instability, or signs of meniscal disease to support a higher rating.  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 pain condition.  

BOARD FINDINGS:  In the matter of the left knee pain 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 20140707, 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 31 May 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:

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

						  	XXXXXXXXXXXXXXXXXXXX
	     				  		Assistant General Counsel
						 	 (Manpower & Reserve Affairs)