RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2015-00994
BRANCH OF SERVICE:  Marine Corps 	SEPARATION DATE:  20080830

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E3, Field Radio Operator, medically separated for “status post ACL reconstruction,” with a disability rating of 10%.  

CI CONTENTION:  “Review 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 - 20080721	VARD - 20081128	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Status Post ACL Reconstruction	5299-5003	10%	Residuals, Post-Op ACL	7805-5024	10%	20081104	
ACL Tear S/P Reconstruction with Ongoing Pain	Cat II					
Joint Pain Localized to Right Knee						
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  10%	

ANALYSIS SUMMARY:  

Status Post ACL Reconstruction.  According to service treatment records and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI underwent right knee surgery in July 2007 for repair of a torn ACL (anterior cruciate ligament) and injuries to medial and lateral menisci.  Following surgery, further treatment did not result in improvement sufficient to allow unrestricted duty.  The MEB forwarded “status post ACL reconstruction” and “anterior cruciate ligament tear” for PEB adjudication.  

At the orthopedic clinic examination on 31 January 2008, 7 months post-surgery and 7 months prior to separation, the CI complained of persistent pain and problems running.  Physical examination indicated the CI had a mildly antalgic gait.  He wore a knee brace on the right knee.  There was no joint line tenderness or muscle atrophy.  The patella tracked normally and all tests for instability were negative.  Range of motion was full and equal to the left knee. 

The MEB NARSUM examination on 21 April 2008, 10 months post-surgery and 4 months prior to separation, noted the CI’s complaint of right knee pain despite post-surgical rehabilitation efforts.  Physical examination showed normal strength.  There was no evidence of an effusion, tenderness or instability of the right knee.  ROM measurements were flexion to 130 degrees (normal 140) and extension to 0 (normal).  

At the 4 November 2008 VA Compensation and Pension (C&P) general medical evaluation, performed 16 months after surgery and 2 months after separation, the CI reported pain and stiffness, but no weakness, swelling or instability in the right knee.  Pain was exacerbated by activity (e.g. playing sports), prolonged walking, standing, and colder weather.  Physical examination showed painful motion and tenderness at the upper portion of the knee.  There was no evidence of instability.  ROM measurements were flexion to 125 degrees (normal 140) and extension to 0 (normal).  

The Board directed attention to its rating recommendation based on the above evidence.  The PEB rated the right knee condition 10%, coded 5299-5003 (arthritis, degenerative). The PEB also listed “ACL tear S/P reconstruction with ongoing pain” and “joint pain localized to the right knee” as related Category II conditions (conditions that contributed to the primary unfitting condition but were not separately ratable).  The VA rated the right knee condition 10% coded 7804-5024 (tenosynovitis, rated as arthritis, degenerative), based on the VA C&P examination 2 months after separation, citing painful or limited motion of a major joint.  The primary right knee functional impairment was secondary to pain.  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.  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.  The 5259 code (cartilage, semilunar, removal of, symptomatic) was applicable in this case but the maximum 10% rating under that code provided no benefit to the CI.  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).  There was 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.  The impairment from the ACL reconstruction and accordant pain was properly subsumed under the overall rating for the Category I right knee condition because there was no evidence of residual instability for dual ratings of the knee.  

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 status post ACL reconstruction (right knee) condition.  

BOARD FINDINGS:  In the matter of the status post ACL reconstruction (right 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 20150607, 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 Oct 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