RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  xxxxxxxxxxxxxxxxxxxxxx 	CASE:  PD-2015-01837
BRANCH OF SERVICE:  marine corps 	SEPARATION DATE:  20050115

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E5, Main Battle Tank Repairer/Technician, medically separated for “medial meniscus tear of the right knee status post partial medial meniscectomy” with a disability rating of 10%.  

CI CONTENTION:  “The condition of my knee has worsen over time and constantly in some pain.”  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 - 20041005	VARD - 20050824	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Right Knee Status Post Partial Medial Meniscectomy	5099-5003	10%	Tearing of the Medial Meniscus of the Right Knee with Ligament Weakness and Degenerative Arthritis	5260	30%	20050329	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  40%	

ANALYSIS SUMMARY:  

Right Knee Status Post Partial Medial Meniscectomy.  According to the service treatment record (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s right knee condition began in 2002 while conducting martial arts training.  The CI underwent right knee surgery on 11 September 2003 for a meniscus tear.  

At the time of the orthopedic clinic appointment on 7 May 2004, he CI reported anterior knee pain.  Examination showed no joint line tenderness and McMurray testing (for meniscal symptoms) was negative.  Range of motion (ROM) was recorded as 0-135 degrees (0-140 normal).  At the orthopedic clinic appointment 19 July 2004 the CI denied locking.  On examination there was no effusion and ROM was noted to be “full.”  The 17 September 2004 MEB NARSUM examination, 4 months prior to separation, noted complaints of persistent medial pain, but no locking after surgery.  Physical examination showed full range of motion, positive medial joint tenderness, negative Lachman’s (for laxity) and a negative pivot (for instability/meniscal symptoms).  

At the 29 March 2005 VA Compensation and Pension (C&P) evaluation, 2 months after separation, the CI reported after surgery he had no more episodes locking, but he continued to have frequent episodes of giving way on average twice a month.  The CI complained of pain in the medial aspect of the right knee on bearing his weight.  The pain worsened after walking more than a mile or sitting more than 30 minutes.  Physical examination showed no evidence of local swelling, heat or redness.  Posture and gait were normal.  There was tenderness at the medial aspect of the right knee.  Right knee ROM was flexion of 15 degrees (normal 140) and extension -5 degrees (normal 0) associated with pain.  ROM was not additionally affected by pain, weakness or fatigue on repetitive use.  There was no evidence of weakness and McMurray testing was negative.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the right knee condition 10%, coded 5099-5003 (arthritis, degenerative).  The VA rated the right knee condition 30%, coded 5260, (leg, limitation of flexion), based on the C&P examination 2 months after separation, citing flexion limited to 15 degrees.  

The panel noted the limitation of the right knee ROM in the NARSUM and orthopedic examinations and other STR documents met the threshold for a 10% rating.  The ROM values reported by the VA examiner 2 months after separation were noted to be significantly worse.  There was no record of recurrent injury or other development in explanation of the more marked impairment reflected by the VA measurements.  The VA examiner also stated that “the patient does not complain of any pain at the medial or lateral aspect of the right knee with pressure on the medial or lateral aspect of the right knee with flexion of 90 degrees” which is not consistent with flexion ROM limitations of 15 degrees.  The significant limitation in flexion is also not consistent with a normal gait and posture as recorded by the VA examiner.  In assigning probative value to these somewhat conflicting examinations, the panel noted that the MEB measurements were consistent with other proximate (pre-separation) examinations and therefore had a higher probative value.  

There was no limitation of motion which supported a rating under the diagnostic codes for limitation of flexion or extension (5260, 5261).  However, there was evidence of painful motion with functional loss supporting a 10% rating based on §4.59.  There was no history or evidence of dislocated meniscus or loose body causing frequent locking with recurrent effusions (5258), to support a rating under that code. The 5259 code (cartilage, semilunar, removal of, symptomatic) was applicable analogously in this case, but the maximum 10% rating under that code provided no benefit to the CI.  There was no fracture, nonunion 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.  

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.  

BOARD 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 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 20160705, 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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