RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXXX	CASE:  PD-2014-03990
BRANCH OF SERVICE:  Marine Corps 	SEPARATION DATE:  20070714

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E2, Satellite Communications Operator, medically separated for “right knee medial plical syndrome,” with a disability rating of 10%.  

CI CONTENTION:  The CI requests the Board consider 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 - 20070517	VARD - 20071023	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Right Knee Plical Syndrome	5099-5003	10%	Right Knee Instability associated with S/P Right Knee Meniscal Repair w/Residuals	5257	10%	20070615	
Patellar Tendinosis	CAT II	S/P Right Knee Meniscal Repair with Residuals	5260	10%	20070615	
Left Knee Medial Plical Syndrome with Patellar Tendinosis	CAT III	Left Knee Patellofemoral Pain Syndrome	5014-5257	10%	20070615	
COMBINED RATING: 10%	COMBINED RATING OF ALL VA CONDITIONS:  40%	

ANALYSIS SUMMARY:  

Right Knee Plical Syndrome.  According to service treatment records and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI underwent right knee surgery in August 2006 for a posterior horn partial medial meniscectomy.  Radiographic studies in January 2007 were normal.  Following surgery further treatment did not result in improvement sufficient to allow unrestricted duty.  The MEB forwarded “plica syndrome” for PEB adjudication.  At the MEB NARSUM examination on 16 April 2007, 3 months pre-separation, the CI reported improvement after surgery, but continued to have pain anteriorly.  The physical examination noted a limping gait and diffuse tenderness circumferentially about the knee joint with pain during all examination maneuvers.  There was no evidence of laxity, and no evidence of ligamentous or meniscal injury.  Right flexion lacked 25 degrees compared to the left of 115 (normal 140), and there was minimal hyperextension (normal 0).  At the MEB examination (recorded on DD Forms 2807 and 2808) dated 24 April 2007, 3 months pre-separation, physical exam showed no effusion, no joint line tenderness, no ligamentous instability, and full range of motion.  There was tenderness to palpation of the medial femoral condyle and strength was 5-/5 on flexion.  

At the VA Compensation and Pension (C&P) examination in June 2007, a month pre-separation, the CI reported constant pain, aggravated by physical activities, and was associated with weakness, stiffness, swelling, giving way, lack of endurance and a locking sensation.  Physical examination showed a normal gait with no evidence of swelling, edema, effusion, weakness, tenderness, abnormal movement or guarding.  There was evidence of anterior cruciate ligament instability (positive drawer sign).  Range of motion was 0-120 degrees with pain, and with no additional limitations after repetition.  

The Board directed attention to the rating recommendation based on the above evidence.  The PEB assigned a 10% rating under an analogous 5099-5003 code (arthritis, degenerative).  The PEB added “patellar tendinosis worsening” as a related Category II diagnosis contributing to the disability.  The VA assigned a dual rating, coding for instability and limitation of flexion: a 10% rating using the 5257 code (knee, other impairment of: recurrent subluxation or lateral instability, slight) and a 10% rating using the 5260 code (leg, limitation of flexion) based on the VA C&P examination a month before separation, and citing limited and painful motion status post meniscal repair with residuals.  

The Board first agreed that the PEB’s Category II diagnosis (“patellar tendinosis worsening”) was intrinsic to the rated condition and a separate rating cannot be supported without pyramiding (VASRD §4.14); thus, it is appropriately subsumed in the same rating.  

The Board next considered the evidence for rating.  The Board deliberated the instability, painful motion, and limitation of flexion documented at the MEB NARSUM, MEB 2808, and VA C&P exams.  There was evidence of painful motion, and functional loss, supporting a 10% rating (based on §4.59, §4.40 and §4.45) and analogously coded 5299-5260 (traumatic arthritis; limitation of flexion).  There were also symptoms (locking) after meniscal removal for a 10% rating coded 5259 (cartilage, semilunar, removal of, symptomatic).  There was no limitation of motion which supported a higher rating under the diagnostic codes for limitation of flexion or extension (5260, 5261).  There was no history of dislocated meniscus with frequent locking, pain, and effusions (5258) in support of a higher 20% rating.  Only the VA examination documented ACL [anterior cruciate ligament] laxity while all other examinations in evidence documented a stable knee.  There were no grounds for additional rating based on the presence of instability; and therefore no VASRD §4.71a route to a rating higher than the 10% adjudicated by the PEB under any applicable code.  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.  

Contended PEB Conditions:  Left Knee Medial Plical Syndrome with Patellar Tendinosis.  The Board’s main charge is to assess the fairness of the PEB’s determination that left knee condition was not unfitting.  The Board’s threshold for countering fitness determinations requires a preponderance of evidence, but remains adherent to the DoDI 6040.44 “fair and equitable” standard.  The left knee condition was listed on the LIMDU [limited duty] as “bilateral medial plica syndrome and bilateral patellar tendinosis.”  It was not specifically implicated in the Non-Medical Assessment and was not judged to fail retention standards.  There was no performance-based evidence from the record that the condition significantly interfered with satisfactory duty performance at separation.  After due deliberation, and 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 contended left knee condition and so no additional disability ratings are recommended.  

BOARD FINDINGS:  In the matter of the right knee condition and IAW VASRD §4.71a, the Board unanimously recommends no change in the PEB adjudication.  In the matter of the contended left knee condition, the Board unanimously recommends no change from the PEB determination as not unfitting.  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 20140912, with attachments
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 6 Jul 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 USN
		- XXXXXXXXXXXXXXXXXXXX, former USMC
		- XXXXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXXXX, former USMC
		- XXXXXXXXXXXXXXXXXXXX, former USMC
		- XXXXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXXXX, former USMC
		- XXXXXXXXXXXXXXXXXXXX, former USMC
		- XXXXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXXXX, former USMC

						XXXXXXXXXXXXXXXXXXXX
	     				  	Assistant General Counsel
						(Manpower & Reserve Affairs)