RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXXXX	CASE:  PD-2015-01863
BRANCH OF SERVICE:  Marine Corps 	SEPARATION DATE:  20060515

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E6, Advanced Aircraft Communications/Navigation Systems Technician, medically separated for “persistent right knee pain after lateral meniscectomy and subsequent lateral meniscal transplant,” with a disability rating of 10%.

CI CONTENTION:  “I have had continued issues with my knee, limiting my physical abilities and underwent 2 additional surgeries following my separation.  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 panel 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 determinations 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 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 - 20060215	VARD - 20070330	
Condition	Code	Rating	Condition	Code	Rating	
Persistent Right Knee Pain after Lateral Meniscectomy and Subsequent Lateral Meniscal Transplant	5299-5003	10%	Right Knee, Status Post Lateral Meniscectomy and Subsequent Lateral Meniscal Transplant	5259	10%	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  30%	

ANALYSIS SUMMARY:  

Persistent Right Knee Pain after Lateral Meniscectomy and Subsequent Lateral Meniscal Transplant.  According to service treatment records (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s right knee condition began in May 2003 during a physical fitness test.  Radiographic studies showed evidence of a lateral meniscal tear.  In October 2003 he underwent a partial lateral meniscectomy.  A repeat lateral meniscectomy was performed in May 2004.  The CI had a right knee lateral meniscal transplant on 2 May 2005.  Following surgery, and two periods of limited duty (LIMDU), further treatment did not result in improvement sufficient to allow unrestricted duty.  The MEB forwarded “pain in joint, lower leg” for PEB adjudication.  

The range of motion (ROM) evaluations in evidence which the Board weighed in arriving at its rating recommendation, with documentation of additional ratable criteria, are summarized in the chart below.  

Right Knee ROM
(Degrees)	Ortho Clinic~6 Mos. Pre-Sep
	NARSUM ~5 Mos. Pre-Sep
	VA C&P ~9 Mos. Post-Sep
	
Flexion (140 Normal)	125	125	140	
Extension (0 Normal)	0	0	0	
Comment	Some increased pain,
Some problem bending knee	Pain/no crepitus/non-tender/Neg. Lachman, anterior drawer and posterior drawer and McMurray’s tests/no laxity/motor strength is 5/5 	ACL/PCL stability tests are normal/medial and lateral collateral ligaments stability tests are normal/medial and lateral meniscus test is normal	
§4.71a Rating	0%	0% (PEB 10%)	0%/10% (VA 10%)	

The CI underwent a right lateral meniscal transplantation surgery on 2 May 2005 (12 months prior to separation).  The findings under anesthesia revealed symmetrical range of motion.  There was no effusion and the ligamentous examination revealed no instability.  The diagnostic arthroscopy revealed a normal appearing patellofemoral joint and suprapatellar pouch.  The medical compartment revealed a normal meniscus and a normal articular cartilage.  The cruciate ligaments were normal as was the articular cartilage on the tibial plateau and the lateral femoral condyle.  The MEB NARSUM, 20 December 2005, noted the CI had continued pain which was exacerbated by standing, walking, running and jumping.  He reported persistent swelling and occasional stiffness.  He denied any locking or catching but did report some clicking and snapping.  He also denied any grinding or instability.  The MEB physical examination noted no erythema, warmth or ecchymosis.  Some mild atrophy of the quadriceps was noted.  The examiner also noted a mild effusion and his lateral patellar facet was tender on palpation and remained tender to palpation along his lateral joint line.  His range of motion was slightly limited (see chart above).  There was pain on patellar compression but there was no patellar crepitus.  The medial joint line was non-tender to palpation.  Lachman, anterior drawer, posterior drawer, McMurray’s and instability testing were all negative.  Sensation was intact in all dermatomes and motor strength was 5/5 throughout.  His condition prohibited him from adequately performing the duties of his MOS as he could not stand or walk for long periods of time and he was unable to march or run.  At the 28 February 2007 VA Compensation and Pension (C&P) evaluation, performed 9 months after separation, the CI reported chronic pain and stiffness limiting physical activity including work.  He stated he could not squat or kneel without intense pain.  Physical examination showed a normal gait and no use of assistive devices for ambulation.  His right knee ROM was normal (see chart above).  He had pain, weakness and lack of endurance on ROM of the right knee.  

The Board directed attention to its rating recommendation based on the above evidence.  The PEB rated the right knee condition 10%, coded analogously 5299-5003 (degenerative arthritis).  The VA rated the right knee condition 10%, coded 5259 (Cartilage, semilunar, removal of, symptomatic), citing pain with use.  The VA additionally rated the right knee surgical scars at 0% under code 7802 (scar(s), due to other causes, not of the head, face, or neck that are superficial and nonlinear) stating “a non-compensable evaluation was assigned for superficial scars that do not cause limited motion and have and area or areas less than 144 square inches (929 sq.cm.).  There was no limitation of motion which supported a rating under the diagnostic codes for limitation of flexion or extension (5260, 5261).  However, the persistence of pain after meniscal surgery warranted a 10% rating under the 5259 code (cartilage, semilunar, removal of symptomatic) as adjudicated by the PEB.  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).  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 Board 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 Board unanimously recommends no change in the PEB adjudication.  There were no other conditions within the Board’s scope of review for consideration.  The Board, 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 20150706, 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
       (b) CORB ltr dtd 26 Apr 17

      In accordance with reference (a), I have reviewed the cases forwarded by reference (b), and, for the reasons provided in their forwarding memorandums, 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:

		- XXXXXXXXXXXXXXXXXXXXX, former USMC
		- XXXXXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXXXXX, former USMC
		- XXXXXXXXXXXXXXXXXXXXX, former USMC
		- XXXXXXXXXXXXXXXXXXXXX, former USMC
		- XXXXXXXXXXXXXXXXXXXXX, former USMC
		- XXXXXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXXXXX, former USMC
		- XXXXXXXXXXXXXXXXXXXXX, former USN 
		- XXXXXXXXXXXXXXXXXXXXX, former USN 
		- XXXXXXXXXXXXXXXXXXXXX, former USMC 
		- XXXXXXXXXXXXXXXXXXXXX, former USMC
		- XXXXXXXXXXXXXXXXXXXXX, former USMC
		- XXXXXXXXXXXXXXXXXXXXX, former USMC
		- XXXXXXXXXXXXXXXXXXXXX, former USMC
		- XXXXXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXXXXX, former USMC

						 XXXXXXXXXXXXXXXXXXXXX
	     				  	Assistant General Counsel
						                				(Manpower & Reserve Affairs)