RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2015-01402
BRANCH OF SERVICE:  Marine Corps 	SEPARATION DATE:  20020531

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E5, Avionics Technician, medically separated for “left knee osteoarthritic chondromalacia changes of medial and lateral compartments” with a disability rating of 10%.  

CI CONTENTION:  The CI’s condition continues to worsen.  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 – 20020403 	VARD - 20020726	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Left Knee Osteoarthritic Chondromalacia Changes of Medial and Lateral Compartments	5003	10%	Chondromalacia Patella, Left Knee	5014	10%	20020517	
Left Knee LMTs, Status Post Debridement	Category II					
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  40%	

ANALYSIS SUMMARY:  

Left Knee.  According to service treatment records (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI developed left knee pain after running long distances in 2000.  He was found to have a lateral meniscal tear (LMT) of his left knee.  This was debrided at arthroscopy 23 March of 2001.  He continued to have pain and a MRI on 1 November 2001 revealed a persistent tear.  He underwent a second left knee arthroscopy on 14 December 2001.  The anterior cruciate and posterior cruciate ligaments (ACL and PCL) were intact at that time.  At an orthopedic follow-up appointment on 25 February 2002, the CI reported persistent pain and “catching” on stairs.  The examination showed motion limited to 120 degrees of flexion (140 is normal), but without fluid or tenderness.  The knee was stable on examination.  It was noted that his second LIMDU expired that day and he was referred for a PEB.  

During the 25 February 2002 MEB NARSUM examination, 3 months prior to separation, the CI reported he was unable to walk with full weight-bearing more than a quarter mile before he had to stop due to pain.  The physical examination showed well-healed surgery scars.  There was no tenderness, swelling, effusion (fluid in the joint), crepitus (an audible or sensible grinding sensation), ligamentous instability or signs of meniscus (internal cartilage cushions) pathology. The examiner recorded that chondromalacia (cartilage deterioration) and a torn meniscus had been repaired at surgery.  It was thought that the CI was unlikely to return to full duty status. Radiographic studies on 17 May 2002 showed no abnormalities.  

At the 17 May 2002 VA Compensation and Pension (C&P) evaluation, 2 weeks before separation, the CI reported pain aggravated by climbing stairs and driving his car.  The physical examination showed normal posture and gait.  There was crepitus with motion and positive patellar grind, but ligamentous laxity and signs of meniscal irritation were absent.  X-rays were normal.  The range of motion (ROM) evaluations in evidence which the Panel weighed in arriving at its rating recommendation, with documentation of additional ratable criteria, are summarized in the chart below.  

Left Knee ROM
(Degrees)	PT/MEB ~3 Mos. Pre-Sep	VA C&P ~2 weeks Pre-Sep	
Flexion (140 Normal)	120	140	
Extension (0 Normal)	0	0	
Comment	No tenderness, no effusion, painful motion was not recorded	Normal gait, painful motion was not recorded	
§4.71a Rating	10%	0%	

The Panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the left knee condition 10%, coded 5003 (arthritis, degenerative).  The Navy PEB listed the meniscus tears as a related diagnosis (Category II) that contributed to the disability in this case.  The Panel agreed that the impairment from the meniscus tear was subsumed under the impairment from the degenerative arthritis and that it could not be separately rated IAW §4.14 (avoidance of pyramiding; more than one rating based on the same impairment is prohibited).  Instability was not present for a separate rating.  The VA also rated the left knee condition 10%, coded 5014 (osteomalacia), citing osteoarthritis of the femoral tibial joint, crepitus, positive patellar grinding, inability to do a full squat and decreased function and impairment with prolonged standing or walking.  The limited motion with X-ray evidence of degenerative arthritis after meniscal surgery would warrant a 10% rating under the 5003 code; the X-rays were normal and the limitation in motion was not compensable on the PEB examination and normal on the VA examination.  The code 5259 (removal of a meniscus) does support a 10% rating in the presence of symptoms.  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.  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 left knee condition.  

PANEL FINDINGS:  In the matter of the left 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 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: PHYSICIU. DISABILITY BOARD OF REVIEW (PDBR) RECOMMENDAT IONS 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

                        XXXXXXXXXXXXXXXXXX
                        Acting