RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2015-01316
BRANCH OF SERVICE:  Marine Corps 	SEPARATION DATE:  20071031

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E6, CH-53 Helicopter Mechanic, medically separated for “right medial knee genu varum and medial compartment gonarthrosis” with a disability rating of 10%.

CI CONTENTION:  The CI requested a review of all conditions.  The CI’s complete submission is at Exhibit A.  

SCOPE OF REVIEW:  The panel’s scope of review is defined in DoDI 6040.44.  It is limited to review of disability ratings assigned 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 or non-compensable.  Any conditions outside the panel’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 panel’s authority is limited to assessing the fairness and accuracy of PEB rating determinations and recommending corrections, where appropriate.  The panel’s assessment of the PEB rating determination 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(s) at the time of separation.  The panel 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 panel 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 - 20070906	VARD - 20090924	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Right Medial Knee Genu Varum and Medial Compartment Gonarthrosis	5299-5263	10%	Chondromalacia, Medial Genu Varum and Medial Compartment Gonathrosis of Right Knee	5024	0%	20090520	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  0%	

ANALYSIS SUMMARY:  

Right Medial Knee Genu Varum and Medial Compartment Gonarthrosis (degenerative changes).  According to service treatment records (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI underwent right knee arthroscopy in November 2006 for medial femoral condyle chondromalacia repair.  Following surgery further treatment did not result in improvement sufficient to allow unrestricted duty.  

The MEB NARSUM, 21 June 2007, 4 months before separation, noted that the CI had a knee brace that had given him full relief during walking but only partial relief with high impact activity.  The examiner also noted that the CI was offered high tibial osteotomy to improve his remaining symptoms, but he declined since the effects would be temporary and he would ultimately need a total knee replacement.  The MEB physical examination noted full range of motion (ROM) with medial joint line tenderness with “overall slight genu varum [bow leg] alignment.”  

At the 20 May 2009 VA Compensation and Pension (C&P) evaluation, performed 29 months after separation, the CI reported chronic pain and weakness.  The examiner noted the CI did not use a crutch, a brace, a cane, or corrective shoes. The condition did affect his usual occupation and daily activities.  On physical examination the gait was normal.  Knee ROM was flexion 130 degrees (normal 140).  There were no callosities, skin breakdown or unusual shoe-wear pattern that would indicate abnormal weight bearing.  There was no pain, weakness, stiffness, swelling, heat, redness, instability, locking, fatigability, lack of endurance or incoordination of movement, there were no functional limitations on standing and walking.  There was “no ankylosis of any joint.” Both legs were of equal length and there was “no evidence of inflammatory arthritis.”  Right knee X-rays on 20 May 2009 were unremarkable.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the right knee condition 10%, coded 5299-5263 (genu recurvatum [hyperextension of the knee joint).  The VA rated the right knee condition 0%, coded 5024 (tenosynovitis), citing no painful or limited motion of a major joint or group of minor joints and no objective evidence showing functional loss due to pain, weakened movement, excessive fatigability with use, incoordination or flare-ups. 

The PEB assigned a 10% rating analogous to 5263 for the “slight genu varum” noted at the MEB NARSUM examination.  Therefore, the panel reviewed to see if a higher rating was supported under any applicable VASRD code.  There was no sufficient limitation of motion (5260, 5261) or history of dislocated meniscus or loose body causing frequent locking with recurrent effusions (5258) to support a higher rating under the respective codes. 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 panel concluded that there was insufficient cause to recommend a change in the PEB adjudication for the right knee condition.  

PANEL FINDINGS:  In the matter of the right knee condition and IAW VASRD §4.71a, the panel unanimously recommends no change in the PEB adjudication.  There were no other conditions within the panel’s scope of review for consideration.  

The panel, 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 20150617, 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

      In accordance with reference (a), I have reviewed the cases listed below and 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:

		- XXXXXXXXXXXXXXXXXX, former USMC
		- XXXXXXXXXXXXXXXXXX, former USMC
		- XXXXXXXXXXXXXXXXXX, former USMC
		- XXXXXXXXXXXXXXXXXX, former USMC
		- XXXXXXXXXXXXXXXXXX, former USMC
		- XXXXXXXXXXXXXXXXXX, former USMC
		- XXXXXXXXXXXXXXXXXX, former USMC

	
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