RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXXX	CASE:  PD-2014-04027
BRANCH OF SERVICE:  Marine Corps 	SEPARATION DATE:  20080715

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E5, Military Police, medically separated for “partial disruption of the posterior cruciate ligament [PCL]” with a disability rating of 20%.

CI CONTENTION:  The VA increased the CI’s rating for his left knee. 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 upon a 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 - 20080319	VARD - 200900120	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Partial Disruption, Left PCL	5262	20%	Left PCL Sprain with Instability	5024-5257	20%	20081014	
COMBINED RATING:  20%	COMBINED RATING OF ALL VA CONDITIONS:  50%	

ANALYSIS SUMMARY:  

Partial Disruption, PCL Left Knee.  According to service treatment records (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s left knee condition began in 2003 during a football game.  At the time of the sports medicine clinic appointment on 5 October 2007, the examiner recorded laxity of the PCL with evidence of instability.  Range of motion (ROM) was noted to be “less than full” and without pain.  There was no surgical indication and conservative treatment did not result in improvement sufficient to allow unrestricted duty. The MEB forwarded “other internal derangement of knee” for PEB adjudication.  In the MEB NARSUM addendum dated 28 February 2008, 6 months prior to separation, the CI reported chronic instability and an inability to run without a brace.  The MEB physical examination noted no effusion, no joint line tenderness, negative Lachman’s and pivot tests and stable varus/valgus stress.  Specific to examining the PCL, the examiner listed the posterior drawer sign as ‘grade II’, indicating a degree of instability.  Left knee ROM was flexion 130 degrees (normal 140) and 5 degrees hyperextension (normal 0).  The VA Compensation and Pension (C&P) examination, dated 14 October 2008, 3 months after separation, noted no crepitus and tests for ligamentous instability and meniscus pathology were negative.  Gait was normal.  The left knee ROM following repetitive movement was normal flexion and extension of -5 degrees (normal 0).  ROM was pain free.  There was no additional limitation in ROM due to repetition.     

The Board directed attention to its rating recommendation based on the above evidence.  Although utilizing different primary codes, both the PEB and VA assigned a 20% rating for the left knee condition.  The PEB used 5262 (tibia and fibula, impairment) whereas the VA analogously used 5024-5257 (tenosynovitis-knee, other impairment).  In deliberating a rating under code 5257 the Board considered the use of a knee brace as well as specific evidence of grade II instability, and concluded that the most accurate description of the CI’s condition was “moderate” (20%) instability under the 5257 code.  There was no limitation of motion which supported a rating under the diagnostic codes for limitation of flexion or extension (5260, 5261).  There was no evidence of painful motion with functional loss supporting a 10% rating (based on §4.59, §4.40 and §4.45) for a dual coding option.  There was no evidence of marked knee disability to support a 30% rating under the 5262 code (tibia and fibula, impairment).  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.  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:  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 20140923, 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)