RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXX	CASE:  PD-2015-01413
BRANCH OF SERVICE:  MARINE CORPS 	SEPARATION DATE:  20071130

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was a Reserve E3, Military Policeman, medically separated for “joint pain, localized to the knee” with a disability rating of 10%.  

CI CONTENTION:  “All conditions are gradually getting worse!!!”  The 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 - 20071002	VARD - 20080416	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Joint Pain, Localized to the Knee	5099-5003	10%	Residuals, Right Knee Injury With Post Traumatic Chondromalacia	5299-5019	10%	20080110	
Shrapnel Wounds to the Right Leg	Cat II	Scars, Thighs, Bilateral, Residuals of Shell Fragment Wounds	7805	0%		
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  30%	

ANALYSIS SUMMARY:  

Joint Pain, Localized to the Knee.  According to the service treatment record and Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s right knee pain began in June 2006 after an improvised explosive device injury.  The pain remained refractory to physical therapy and a January 2007 diagnostic right knee arthroscopy revealed no meniscal tear.  The 20 August 2007 MEB NARSUM examination, 3 months prior to separation, noted CI complaints of continued and worsening pain after arthroscopic surgery, described as a grinding sensation deep in the knee, without radiation.  He experience occasional edema and stiffness, and pain was exacerbated by prolonged walking or knee extension.  Physical examination showed a normal gait, no effusion and a full active range of motion (ROM) without crepitus.  During the 8 September 2007 MEB examination (recorded on DD Forms 2807-1 and 2808), 2 months prior to separation, the CI reported impaired right knee use due to shrapnel and arthroscopic surgery.  He could not stand for long periods or perform the Army physical fitness test run due to right knee pain.  

At the 10 January 2008 VA Compensation and Pension (C&P) evaluation, 2 months after separation, the CI complained of daily sharp pain, generally rated at 2-3/10, but starting at 4/10 in the morning with stiffness.  He went to the gym 5 times per week and noted that running on a treadmill increased the pain level to 8/10 after 20 minutes.  The pain also increased when climbing stairs or performing squats.  Physical examination revealed no pain on deep palpation of the joint.  ROM showed flexion to 140 degrees (normal) and extension of 0 degrees (normal) with increased pain at the end limits of motion.  Repeated motion did not result in weakness, fatigue, lack of endurance, incoordination or decreased ROM.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the knee pain condition 10%, coded 5099-5003 (analogous to arthritis, degenerative).  
The PEB listed the right leg shrapnel wounds as a related diagnosis (Category II) that contributed to the disability.  Members agreed the shrapnel wounds were related to the joint pain condition and could not be separately rated IAW §4.14 (avoidance of pyramiding; more than one rating based on the same impairment is prohibited).  The VA rated the right knee injury residuals with post traumatic chondromalacia condition 10%, coded 5299-5019 (analogous to bursitis), based on the C&P examination 3 months after separation, citing painful or limited motion of a major joint or group of major joints. While there was no limitation of motion that supported a rating under the diagnostic codes for limitation of flexion or extension (5260, 5261), the panel noted evidence of painful motion with functional loss supporting a 10% rating (based on §4.59, §4.40 and §4.45).  There was no history or evidence of dislocated meniscus or loose body causing frequent locking with recurrent effusions (5258), or history of surgery to remove a meniscus (5259) to support a rating under those codes.  There was therefore no VASRD §4.71a route to a rating higher than the 10% adjudicated by the PEB under any applicable code.  After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the panel concluded there was insufficient cause to recommend a change in the PEB adjudication for the right knee pain condition.  

BOARD FINDINGS:  In the matter of the right knee pain condition and IAW VASRD §4.71a, the panel unanimously recommends no change in the PEB adjudication.  There are no other conditions within the panel’s scope of review for consideration.  The panel, therefore, recommends 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 20150619, 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:

		- XXXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXXX, former USMC
		- XXXXXXXXXXXXXXXXXXX, former USMC
		- XXXXXXXXXXXXXXXXXXX, former USMC
		- XXXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXXX, former USMC

		
	XXXXXXXXXXXXXXXXXXX  					
         Acting