RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXXX	CASE:  PD-2014-03714
BRANCH OF SERVICE:  Marine Corps 	SEPARATION DATE:  20020315

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E4, Logistics Vehicle System Operator, medically separated for “medial femoral condylar cartilage disorder status post OATS [osteochondral autograft transfer system] procedure,” with a disability rating of 10%.

CI CONTENTION:  The CI requested consideration of all conditions.  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 – 20011218	VARD – 20020412	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Medial Femoral Condylar Cartilage Disorder Status Post OATS Procedure	5259-5003	10%	Residuals. Anterior Cruciate Ligament Reconstruction
Right Knee with Osteoarthropathy	5003-5262	10%	20020222	
Lateral Meniscus Tear Status Post Partial Lateral Meniscectomy	Cat II					
MediaI Meniscal Tear Status Post Partial Medial Meniscectomy						
Right Anterior Cruciate Ligament Tear Status Post Reconstruction						
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  40%	

ANALYSIS SUMMARY:  

Right Leg Injury.  According to the service treatment record and Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI sustained multiple sports-related injuries to her right knee over a period several years.  Diagnostic imaging revealed meniscal and anterior cruciate ligament (ACL) tears.  She underwent a right ACL reconstruction with meniscal debridement in June 2000.  The examiner noted that “postoperatively, [the CI] did well with regards to her stability issues.”  Due to persistent pain coupled with evidence of denuded areas of cartilage as seen in the previous surgery, the CI underwent an arthroscopic OATS procedure in June 2001.  Following the OATS procedure, further treatment did not result in improvement sufficient to allow unrestricted duty.  The MEB forwarded “right ACL tear status post reconstruction,” “medial meniscal tear status post partial medial meniscectomy,” “lateral meniscus tear status post partial lateral meniscectomy,” and “medial femoral condylar cartilage disorder status post OATS procedure” for PEB adjudication.  At the MEB NARSUM examination, dated 10 August 2001, (7 months prior to separation), the CI reported the ability to walk but had discomfort with impact activities.  The MEB physical examination (PE) revealed joint line tenderness of the right knee.  Her range of motion (ROM) of the right knee was 10 degrees short of full ROM; equating to flexion of 130 degrees.  Knee extension was normal.  Maneuvering tests for instability were negative.  

At the VA Compensation and Pension (C&P) examination, dated 22 February 2002, (a month prior to separation), the CI reported constant pain associated with weakness, stiffness, swelling, inflammation, locking, fatigue and lack of endurance in both knees and aggravated by exercise.  Her PE revealed a mild limp on the right leg.  There was swelling about the right knee.  Knee ROM was normal, but painful and additionally limited by fatigue, weakness, lack of endurance, and incoordination.  Although the VA provider noted that both knees “appeared to have a significant amount of instability,” the same encounter documented instability maneuvers as negative.        

The Board directed attention to its rating recommendation based on the above evidence.  The PEB rated the right knee condition 10%, using an analogous code, 5299-5003, (degenerative arthritis) without citing rationale.  The Board noted the three additional diagnoses determined to be category II conditions (conditions that contribute the primary unfitting condition but are not separately ratable) were intertwined diagnoses and the overall knee impairment from all listed diagnoses were subsumed under the ratings for the knee by both the PEB and the VA.  More than one rating based on the same impairment is prohibited IAW §4.14 (avoidance of pyramiding).  The VA rated the right knee condition 10%, using a combined code 5003-5262, (degenerative arthritis-impairment of tibia and fibula) citing mal-union of the tibia and fibula with slight knee disability.  There was no limitation of motion which supported a rating under the diagnostic codes for limitation of flexion or extension (5260, 5261). However, there was evidence of painful motion with functional loss supporting a 10% rating (based on §4.59, §4.40 and §4.45) as adjudicated by the PEB.  

Board members agreed that although the VA provider noted both knees “appeared to have a significant amount of instability and weakness,” the examiners inconsistent documentation as to negative instability tests did not show evidence of a true condition of instability.  Members concluded that there was no VASRD §4.71a route to a higher rating under any applicable code, and no grounds for additional rating based on the presence of instability.  The examinations proximate to separation did not demonstrate the presence of ligamentous instability or laxity (5257), and there was no history of dislocated meniscus or loose body causing frequent locking with recurrent effusions (5258), to support a rating under the respective codes.  There was no fracture, non-union, or mal-union of the femur or tibia to support consideration under the respective codes for knee impairment related to long bone conditions (5255, 5262).  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:  In the matter of the right leg 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 20140720, 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 21 Jun 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 USMC
		- XXXXXXXXXXXXXXXXXXXX, former USMC
		- XXXXXXXXXXXXXXXXXXXX, former USMC
		- XXXXXXXXXXXXXXXXXXXX, former USMC

						 XXXXXXXXXXXXXXXXXXXX	     				  			  		Assistant General Counsel
						 (Manpower & Reserve Affairs)