RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXX	CASE:  PD-2016-00298
BRANCH OF SERVICE:  Marine Corps 	SEPARATION DATE:  20050701

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

CI CONTENTION:  The CI contends for his unfitting right knee condition stating that the condition limits his employment opportunities, and to review all conditions.  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 - 20050325	VARD - 20060929	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Right Knee Lateral Meniscus Tear	5099-5003	10%	Retropatellar Pain Syndrome, Right Knee	5260	0%	20060714	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  0%	

ANALYSIS SUMMARY:  

Right Knee Lateral Meniscus Tear.  According to the service treatment record (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s right knee condition began in January 2004 following a 3 mile run in basic training.  Magnetic resonance imaging (MRI) done on 5 February 2004 showed a tear of the anterior horn of the lateral meniscus.  The orthopedic surgeon determined that the tear was not appropriate for surgical intervention.  Despite and 8-month course of physical therapy and conservative treatment, the right knee condition could not be adequately rehabilitated to meet the physical requirements of the CI’s military specialty.  
At the 26 August 2004 orthopedics examination, the CI reported pain with running and with excessive walking as well as with sitting.  He also reported swelling and locking when in extreme extension.  The physical examination showed minimal tenderness over the right lateral patella, with no joint line tenderness.  McMurray’s test (for meniscal pathology) was negative, and there was a positive A1 Lachman’s (minimal laxity).  There was no muscle atrophy and right knee range of motion (ROM) was -5-120 degrees (normal 0-140).  

The 1 September 2004 MEB NARSUM examination, 10 months before separation, noted complaints of continued right knee pain with the inability to run more than 1/4 mile or other activities required of the Recon training program.  The CI described his pain as occurring 100% of the time and causing sleep disturbance.  The physical examination showed mild joint line pain at the lateral aspect of the right knee with an equivocal McMurray’s test (for meniscal pathology).  There was no effusion or instability.  ROM was “full at” 0-135 degrees (VASRD normal 0-140).  

At the 14 July 2006 Compensation and Pension (C&P) evaluation, 12 months after separation, the CI reported current pain in the right knee described as 5/10 with stiffness and weakness with prolonged nonuse and occasional swelling, instability, locking and lack of endurance.  He was using a brace but stated he had no problems with activities in daily living (ADLs).  The physical examination showed no signs of laxity, instability or meniscal pathology.  There was no pain, weakness or tenderness.  ROM was 0-120 degrees, with the examiner specifically stating that the limitation was due to body habitus.  There was no change in ROM measurements after repetition.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the right knee condition 10%, coded 5099-5003 (degenerative arthritis).  The VA rated the right knee condition 0%, coded 5260 (leg limitation of flexion of) stating that his right knee condition did not rise to the level of the 10% rating.  

There was no limitation of motion which supported a rating under the diagnostic codes for limitation of flexion or extension (5260, 5261).  The CI had a history of meniscus damage with evidence of tenderness with functional loss supporting a 10% rating (based on §4.59, §4.40 and §4.45) analogous to rating under code 5259 (cartilage, semilunar, removal of, symptomatic), which was equivalent to that adjudicated by the PEB.  There was insufficient evidence of a loose body causing frequent locking with recurrent effusions (5258) to support any higher meniscal rating.  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.  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 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 20160413, 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:

		- XXXXXXXXXXXXXXXXXXX, former USMC
		- XXXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXXX, former USMC
		- XXXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXXX, former USMC
		- XXXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXXX, former USMC
		- XXXXXXXXXXXXXXXXXXX, former USMC