RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXXX	CASE:  PD-2015-00268
BRANCH OF SERVICE:  MARINE CORPS	SEPARATION DATE:  20051031

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E5, Fixed Wing Aircraft Airframe Mechanic, medically separated for “left knee pain,” rated at 10%.  

CI CONTENTION:  The CI contends for his unfitting left knee and two conditions not identified by either the MEB or PEB.  The applicant’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 - 20050817	VARD - 20051220	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Left Knee Pain	5299-5003	10%	Residuals, Post Operative Meniscus Tear, L Knee	5259	10%	20050917	
S/P Partial Lateral Menisectomy	Cat II					
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  20%	

ANALYSIS SUMMARY:  

Left Knee Pain and S/P Partial Menisectomy.  According to service treatment records and the Medical Evaluation Board (MEB) narrative summary (NARSUM-4 months prior to separation), the CI was cleared for service entry with an asymptomatic left knee and pre-service surgery.  The CI re-injured his knee in April 2003, had left knee pain and locking, and underwent left knee surgery in January 2004 for repair of a torn left knee meniscal cartilage (partial menisectomy).  

The CI continued to have left knee pain and reasonably declined the option of meniscal transplant.  Despite treatment, the CI’s knee condition could not be adequately rehabilitated to meet the physical requirements of the CI’s military specialty and was referred for MEB.  The NARSUM noted normal gait, no effusion, good thigh muscle (quadriceps) tone, no patella apprehension, and no instability.  He had lateral joint line tenderness.  Lachman showed a trace of anterior laxity with a solid endpoint, and no posterior glide.  Surgical portals were well healed.  Flexion was to 125 degrees (normal 140) “without difficulty.”  

At the VA Compensation and Pension (C&P) examination performed 1 month before separation, the CI reported pain around his knee, denied swelling but complained of pain and stiffness with activity, and no incapacitation.  Examination of the knees showed normal gait and appearance, bilateral crepitus, and no appreciable scar on either knee.  McMurray’s and Drawer tests were within normal limits.  There were no appreciable scars.  Range-of-motion (ROM) was from 0-120 degrees (normal 0-140) without pain or decrease on repetition.  

The Board directed attention to its rating recommendation based on the above evidence.  The PEB rated the left knee condition 10% coded 5299-5003 (degenerative arthritis), citing pain.  The VA also rated the left knee condition 10% coded 5259 (cartilage, semilunar, removal of, symptomatic), citing ROM criteria and crepitus.  There was no limitation of motion which attained a minimum rating under the diagnostic codes for limitation of flexion or extension (5260, 5261).  However, there was evidence of functional loss supporting a 10% rating (based on §4.40 and §4.45) as adjudicated by the PEB.  The examinations proximate to separation did not demonstrate the presence of ligamentous instability or significant laxity (5257), frequent locking with effusions or any indication of dislocated meniscus or loose body (5258).  There was no fracture, non-union, or malunion of the femur or tibia to support consideration under the respective codes for knee impairment related to long bone conditions (5255, 5262).  Meniscal rating under code 5259 (as used by the VA) encompasses painful motion, and there was insufficient evidence for dual rating of the knee.  There is therefore no VASRD §4.71a route to a rating higher than the 10% adjudicated by the PEB under any applicable code, and no grounds for additional rating based on the presence of instability.  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 20150414, 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 19 Sep 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, former USMC
	- XXXXXXXXXXXXXXXXXXXX, former USMC
	- XXXXXXXXXXXXXXXXXXXX, former USMC
	- XXXXXXXXXXXXXXXXXXXX, former USMC 

				XXXXXXXXXXXXXXXXXXXX
	     			Assistant General Counsel
				 (Manpower & Reserve Affairs)