RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME: XXXXXXXXXXXXXXXXXX	CASE: PD-2015-01931
BRANCH OF SERVICE:  Marine Corps	SEPARATION DATE:  2005-08-01

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was a Marine Corps Reservist, Field Wireman, medically separated for “bilateral knee pain” with a disability rating of 0%.  

CI CONTENTION:  “Prior to service I did have a documented preexisting injury of my right knee.  However there was no known injury in my left knee prior to the completion of my Marine Corps training.”  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 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.  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 Board’s authority is limited to assessing the fairness and accuracy of PEB rating determinations and recommending corrections, where appropriate.  The Board’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 Board 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 Board 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 - 20050601	VARD – 20060314 	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Bilateral Knee Pain	5299-5003	0%	Mild Arthritis, Right Knee…	5257-5003	0%	20050621	
S/P Right ACL Reconstruction 	Cat II					
Left Knee Arthroscopy…		Mild Arthritis, Left Knee…	5260-5003	0%		
COMBINED RATING:  0%	COMBINED RATING OF ALL VA CONDITIONS:  0%	

ANALYSIS SUMMARY:  

Bilateral Knee Pain.  According to service treatment records (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s right knee condition existed prior to service (EPTS).  He received a waiver for the right anterior cruciate ligament (ACL) reconstruction performed in 1999; which was noted as asymptomatic at the time of entry into service.  The left knee condition began in August 2003 during military training.  The CI underwent left knee arthroscopy on 30 June 2004 with the removal of fibrous tissue and debridement.  At an orthopedic evaluation on 5 October 2004, 4 month after surgery, the CI reported intermittent swelling of the left knee, sticking of the patella, and popping.  He denied left knee pain.  The physical examination showed full, painless active range of motion (ROM) bilaterally.  There was no joint line tenderness.  Motor strength was normal bilaterally.  The examiner noted trace anterior cruciate ligament instability on the left: however, the instability was noted as associated with the site of the prior to service anterior cruciate ligament reconstruction which was on the right.  

The 31 March 2005 MEB NARSUM examination, 5 months prior to separation, noted complaints of pain in the CI’s knees, with running.  The CI denied any instability, but used an ACL brace with his right knee.  The physical examination showed no effusion, medial or lateral joint line tenderness, instability, crepitation, or mechanical block to motion. There was full range of motion bilaterally and well healed incisions.  

At the 21 June 2005 VA Compensation and Pension (C&P) evaluation, 2 months before separation, the CI reported pain with increased activity and loading.  The physical examination showed normal ROM of bilateral knees.  There was no localized pain on deep palpation the mediolateral joint compartment bilaterally.  There was a 1+ crepitus elucidated from the right and left knee patellofemoral joint.  An addendum noted no additional limitation of motion, painful motion, weakness or lack of endurance with repetitive motion.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the bilateral knee pain condition 0%, coded 5299-5003 (Arthritis, degenerative (hypertrophic or osteoarthritis).  The VA rated the mild arthritis, right knee, status post anterior cruciate ligament reconstruction condition 0%, coded 5257-5003 (Arthritis, degenerative (hypertrophic or osteoarthritis) and mild arthritis, left knee, status post arthroscopy and debridement of chondrosis and removal of loose body condition 0%, coded 5260-5003, citing mild arthritis of both knees.  

The panel first looked at whether the bilateral knee condition warranted unbundling and was “reasonably justified as separately unfitting.”  Both knees were profiled and implicated in the commander’s statement.  Panel members agreed that each knee was reasonably justified as separately with identical rating and coding.  There was no evidence of painful motion with functional loss supporting a 10% rating (based on §4.59, §4.40 and §4.45).  There likewise was no limitation of motion which attained a 10% rating under the diagnostic codes for limitation of flexion or extension (5260, 5261).  There was no post-surgical history loose body causing frequent locking with recurrent effusions (5258) to support a rating under that code.  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).  No additional functional limitation was evidenced by the examinations.  Therefore the panel concluded there was not sufficient evidence to support a rating higher than the 0% adjudicated by the PEB.  The panel noted that the Category II conditions were surgeries associated with each knee and determined that they were appropriately adjudicated as contributing to the unfitting condition and not separately unfitting.  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 bilateral knee pain condition.  

BOARD FINDINGS:  In the matter of the bilateral knee pain 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 modification or re-characterization of the CI’s disability and separation determination.  

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 3/23/2020 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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