RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2015-01728
BRANCH OF SERVICE:  MARINE CORPS 	SEPARATION DATE:  20071115

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E7, Tactical Data Systems Administrator, medically separated for “old ACL tear status post repair and revision, left knee,” with a disability rating of 20%.

CI CONTENTION:  The CI contended he was only rated for his left knee and his back and migraines were not rated.  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 - 20070611	VARD - 20131118	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Old ACL Tear Status Post Repair and Revision, Left Knee	5299-5262	20%	Left Knee Strain Status Post Multiple Ligament Injuries and Surgery with Degenerative Joint Disease	5010-5260	10%	20130725	
			Left Knee Limitation of Extension	5010-5261	0%	20130725	
Old MCL Tear Status Post Repair	Cat II					
Chondromalacia Patella	Cat II					
COMBINED RATING:  20%	COMBINED RATING OF ALL VA CONDITIONS:  20%	

ANALYSIS SUMMARY

Left Knee Pain Condition.  According to the service treatment record (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI had a history of repeated surgeries to the left knee.  The first surgery was in 1994.  In August 2000 he underwent a repeat arthroscopic surgery with reconstruction of his anterior cruciate ligament (ACL) and debridement of a medial meniscus tear.  In May 2003 he underwent a revision of his prior ACL repair as well as a medial collateral ligament (MCL) repair and lateral meniscectomy.  In May 2005 the ACL graft again required surgical revision.  The CI’s last last surgical procedure was performed in January 2007 which noted significant chondromalacia of the kneecap.  

The 6 February 2007 MEB NARSUM examination, 4 months prior to separation, noted complaints of left knee pain and the inability to run or stand for prolonged periods.  His physical examination (PE) revealed a mildly antalgic gait and near normal range of motion (ROM) of the left knee.  The left knee ROM was documented as flexion of 135 degrees (normal = 140) and extension as normal with pain initiated at extreme flexion.  During the 23 April 2007 MEB examination (recorded on DD Forms 2807-1 and 2808), 2 months prior to separation, the CI reported chronic left knee pain. His PE revealed full ROM without pain.  The 25 July 2013 VA Compensation and Pension (C&P) evaluation was over 5 years after separation and contained no probative value for assessing disability at or near the time of separation.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the left knee condition 20%, coded 5299-5262 (tibia and fibula, impairment of with moderate knee disability).  The PEB also found “old MCL tear status post repair” and “chondromalacia patella” to be related category 2 conditions.  The VA rated the left knee strain status post multiple ligament injures and surgery with degenerative joint disease 10%, coded 5010-5260, (leg limitation of flexion), citing painful motion.  They also rated left knee limitation of extension 0%, coded 5010-5261 (leg limitation of extension) based on the C&P examination over 5 years after separation, citing limitation of extension of 5 to 9 degrees.    

There was no evidence of marked knee disability to support a 30% rating under the 5262 code (tibia and fibula, impairment of).  There was no limitation of motion (5260, 5261), and no history or evidence of dislocated meniscus or loose body causing frequent locking with recurrent effusions (5258) to support a higher rating under these respective codes.    All panel members agreed that the two additional diagnoses determined to be Category II conditions (conditions which contributed to the primary unfitting condition but were not separately ratable) were intertwined diagnoses, and the overall knee impairment from all listed diagnoses was subsumed under the ratings for the knee by the PEB.  More than one rating based on the same impairment is prohibited, IAW §4.14 (avoidance of pyramiding).   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.

BOARD FINDINGS:  In the matter of the left knee condition and IAW VASRD §4.71a, the panel unanimously recommends no change in the PEB’s adjudication.  There are no other conditions within the panel’s scope of review for consideration.  The panel, 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 20150630, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record 

MEMORANDUM FOR DEPUTY COMMANDANT, MANPOWER & RESERVE AFFAIRS
		   COMMANDER, NAVY PERSONNEL COMMAND	
	                          
Subj:  PHYSICAL DISABILITY BOARD OF REVIEW (PDBR) RECOMMENDATIONS          

Ref:  (a) DoDI 6040.44
	(b) PDBR ltr dtd 31 Jul 17 XXXXXXXXXXXXXXXXXX
	(c) PDBR ltr dtd 06 Jul 17 XXXXXXXXXXXXXXXXXX  
	(d) PDBR ltr dtd 31 Jul 17 XXXXXXXXXXXXXXXXXX
	(e) PDBR ltr dtd 31 Jul 17 XXXXXXXXXXXXXXXXXX
	(f) PDBR ltr dtd 07 Jul 17 XXXXXXXXXXXXXXXXXX
	(g) PDBR ltr dtd 02 Aug 17 XXXXXXXXXXXXXXXXXX
	(h) PDBR ltr dtd 06 Jul 17 XXXXXXXXXXXXXXXXXX

1.  Pursuant to reference (a), the recommendations of the Physical Disability Board of Review set forth in references (b) through (h) are approved.  The official records of the following individuals are to be corrected as follows:

     a. XXXXXXXXXXXXXXXXXX, former USMC: Entitlement to disability separation pay with a 20 percent disability rating (increased from 10 percent) effective date of discharge. 

     b. XXXXXXXXXXXXXXXXXX, former USMC: Placement on the Permanent Disability Retired List with a 30 percent rating (increased from 20 percent) effective date of discharge.      

     c. XXXXXXXXXXXXXXXXXX, former USMC: Entitlement to disability separation pay with a 20 percent disability rating (increased from 10 percent) effective date of discharge.

     d. XXXXXXXXXXXXXXXXXX, former USMC: Placement on the Permanent Disability Retired List with a 30 percent rating (increased from 10 percent) effective date of discharge. 

     e. XXXXXXXXXXXXXXXXXX, former USMC: Entitlement to disability separation pay with a 20 percent disability rating (increased from 10 percent) effective date of discharge.

     f. XXXXXXXXXXXXXXXXXX, former USMC: Entitlement to disability separation pay with a 10 percent disability rating (increased from 0 percent) effective date of discharge.   

     g. XXXXXXXXXXXXXXXXXX, former USN: Placement on the Permanent Disability Retired List with a 30 percent rating (increased from 20 percent) effective date of discharge.       
     
3.  Please take action to implement these decisions.

	XXXXXXXXXXXXXXXXXX
	Acting,