RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2015-01231
BRANCH OF SERVICE:  Marine Corps 	SEPARATION DATE:  20030315

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E6, Imagery Analysis Specialist, medically separated for “early degenerative arthritis of the knee,” with a  disability rating of 10%.

CI CONTENTION:  The CI made a lengthy contention for his unfit condition along with numerous other conditions.  His 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 - 20021125	VARD - 20030723	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Early Degenerative Arthritis of the Knee	5299-5003	10%	Left Knee Condition	5257	NSC	---	
Residual Flexion Contracture	Cat II					
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  NSC	

ANALYSIS SUMMARY:  

Right Knee Arthritis.   According to service treatment records (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI underwent three right knee surgeries: a medial meniscectomy (October 1998), an anterior cruciate ligament (ACL) reconstruction (May 2000) and a debridement of a lateral meniscal tear (26 July 2002).  Despite surgery, further treatment did not result in improvement sufficient to allow unrestricted duty.  The MEB forwarded “residual flexion contracture” and “early degenerative arthritis of the knee” for PEB adjudication.

The MEB NARSUM examination on 13 August 2002, one month after the third surgery and 7 months prior to separation, the examiner noted complaints of constant right knee pain.  The physical examination (PE) revealed the presence of a flexion contracture (inability to straighten the knee actively or passively).  ROM was recorded as 130 degrees of flexion (normal 140) and extension limited to 7 degrees (normal 0).  Crepitus was present upon flexion.  There was no effusion and all tests for instability were negative. During a sports medicine examination dated 30 May 2003, 3 months after separation, the CI reported continued right knee pain, exacerbated by walking.  Additionally, he endorsed the feeling as though his knee was not trustworthy and could give out at times.  His PE revealed right knee tenderness as well as pain with compression of the kneecap.  ROM demonstrated 140 degrees of flexion and 10 degrees limitation of extension with crepitus noted.  There was no effusion and all tests for instability were negative.  There was no VA Compensation and Pension examination within the case file for the CI “failed to report” for a scheduled examination proximate to separation.  

The Board directed attention to its rating recommendation based on the above evidence.  The PEB rated the right knee condition at 10%, analogously coded 5299-5003 (degenerative arthritis).   The Navy PEB listed the residual flexion contracture condition as a related diagnosis (Category II) that contributed to the primary disability in this case.  The Board agreed that the flexion contracture was a secondary diagnosis related to the early degenerative arthritis of the knee and therefore, was not a separate condition which could be separately rated IAW §4.14 (avoidance of pyramiding; more than one rating based on the same impairment is prohibited).  Approximately 4 years after separation, the VA rated the right knee condition 10%, coded 5261 (leg, limitation of extension), based on STR and post-separation treatment records, citing extension of the leg limited to 10 degrees.   The Board considers post-separation evidence normally within 12 months of separation as probative to the condition at or near separation.

All Board members agreed that the sports medicine evaluation conducted at 3 months post-separation held significant probative value in this case due to its close proximity to separation.  The documented limitation of motion clearly supported a rating under the diagnostic code for limitation of extension (5261).  Evidence of painful motion with functional loss was also present thus supporting a 10% rating (based on §4.59, §4.40 and §4.45) as adjudicated by the PEB.  Either way, the evidence supports a route to a 10% rating in this case.  

No examinations proximate to separation demonstrated 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.

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’s adjudication for the right knee condition.  

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.  There were no other conditions within the Board’s scope of review for consideration.  The Board, therefore, recommends that there be no modification or re-characterization of the CI’s disability and separation determination.  

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20150615, 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