RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2015-02174
BRANCH OF SERVICE:  Marine Corps 	SEPARATION DATE:  20040430

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E3, Machine Gunner, medically separated for right knee pain with a disability rating of 10%.

CI CONTENTION:  Contends injury is both physically and mentally damaging.  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 - 20040310	VARD - 20040708	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Status Post Right Anterior Cruciate Ligament Reconstruction with Chronic Patellofemoral Pain Syndrome	5099-5003	10%	Status Post Right Knee ACL Reconstruction and Lateral Meniscectomy with Residual Patellofemoral Pain Syndrome	5259	10%	20040104	
			Right Knee Scars, Post Surgery	7802	0%		
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  10%	

ANALYSIS SUMMARY:  

Status Post Right Anterior Cruciate Ligament Reconstruction with Chronic Patellofemoral Pain Syndrome.  According to service treatment record (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI injured his right knee on 25 March 2003 while fast roping.  Initial treatment consisted of Motrin (ibuprofen, a nonsteroidal anti-inflammatory drug (NSAID)) and Vicodin (oxycodone, a narcotic and acetaminophen, a pain reliever), ice, and light duty.   Examination on 7 April 2003 revealed edema of the right knee with ecchymosis (black and blue discoloration) posteriorly with a full range of motion (ROM) and no laxity; however, on examination on 9 April 2003 laxity was noted raising the diagnosis of a probable anterior cruciate ligament (ACL) defect.  The CI underwent right knee anterior cruciate ligament (ACL) reconstruction and partial lateral meniscectomy on 17 June 2003 followed by postoperative physical therapy.  At an orthopedic clinic visit on 12 August 2003 the ROM of the right knee was 0-130 degrees without laxity and at a physical therapy visit the ROM was 0-135 degrees without laxity.  At follow-up orthopedic visits in October and December 2003 the CI had a full ROM with no laxity by December 2003.  Following surgery further treatment did not result in improvement sufficient to allow unrestricted duty.  The MEB forwarded “status post right anterior cruciate ligament reconstruction with chronic patellofemoral pain syndrome” for PEB adjudication.  

The 9 December 2003 MEB NARSUM examination, 4 months prior to separation, noted complaints of anterior knee pain over the prior 3 months.  Physical examination showed a full ROM, stability to varus and valgus stresses at 0 and 30 degrees, some tenderness and discomfort with patellar compression, no effusion, and no laxity (negative anterior drawer and Lachman tests).  The examiner felt the CI had plateaued in terms of rehabilitation and was limited from jumping or marching and was referred to the PEB.  During the 18 December 2003 MEB examination (recorded on DD Forms 93 and 2808), 4 months prior to separation, the CI reported surgery to correct a torn ACL and meniscus, which was still painful and swollen at times.  The physical examiner noted right knee meniscus and ACL reconstruction surgery and limited ROM with pain.  

At the 1 April 2004 VA Compensation and Pension (C&P) Internal Medicine evaluation, 1 month prior to separation, the CI reported when he tried to run he had pain in the right knee, but denied any incapacitation and took no medication.  On examination he had a normal gait and did not require an assistive device.  Physical examination showed two non-disfiguring scars present on the medial and lateral patella (kneecap), which were soft and nontender.  There was a slight clicking sound of the right knee without heat redness, swelling, effusion, drainage, instability or weakness.  ROM was full (140 degrees) without pain or limitation of motion on repetition.  There was no evidence of muscle atrophy of the right lower extremity and neurologic evaluation was unremarkable.  X-rays of the right knee dated 1 April 2004 showed no abnormality in the knee, but there was a small rectangular linear density with four small holes embedded in the anterior cortex of the distal femoral shaft slightly lateral to the midline.    

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the right knee condition 10%, analogously coded 5099-5003 (arthritis, degenerative).  The VA rated the right knee condition 10%, coded 5259 (cartilage, semilunar, removal of, symptomatic), based on the C&P examination 4 months after separation, citing normal ROM without pain.  The VA also rated right knee scars (not in the scope of review) that caused limited motion and pain.  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, §4.40 and §4.45) 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).  However, code 5259 does offer a 10% rating, but it does not afford any additional benefit to the CI. Therefore, there was 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 panel concluded that there was insufficient cause to recommend a change in the PEB adjudication for the status post right anterior cruciate ligament reconstruction with chronic patellofemoral pain syndrome condition.  

PANEL FINDINGS:  In the matter of the status post right anterior cruciate ligament reconstruction with chronic patellofemoral pain syndrome 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, 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

		- XXXXXXXXXXXXXXXXXX former USMC
	 	- XXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXX, former USMC
		- XXXXXXXXXXXXXXXXXX, former USMC
		- XXXXXXXXXXXXXXXXXX, former USMC

		
	
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	     				  Acting