RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2017-00664
BRANCH OF SERVICE:  marine corps	SEPARATION DATE:  20040731

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty O3, F/A-18 Pilot, medically separated for “chronic right knee pain” with a disability rating of 10%.

CI CONTENTION:  “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 Medical Evaluation Board (MEB), but determined by the PEB 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.  The panel’s authority is limited to assessing the fairness and accuracy of PEB rating determinations and recommending corrections when appropriate.  The panel’s assessment of the PEB rating determination is based on review of medical records and all available evidence relevant to application of the Veterans Affairs Schedule for Rating Disabilities (VASRD) standards for 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, which operates 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 disability at the time of separation.

RATING COMPARISON:

SERVICE PEB - 20040226	VARD - 20041208	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Right Knee Pain	5260	10%	Status Post Right Tibial Plateau Fracture with Degenerative Joint Disease	5010-5260	10%	20040803	
Depressive Disorder	Category II	Major Depressive Disorder, Single Event	9434	NSC	20040803	
Anxiety Disorder						
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  30%	

ANALYSIS SUMMARY:

Chronic Right Knee Pain.  According to the service treatment record (STR) and MEB narrative summary (NARSUM), the CI underwent right knee anterior cruciate ligament surgery in July 1984.  He then sustained a right knee fracture and dislocation on 26 July 2002 when he ejected from his aircraft, and underwent a right tibial plateau fixation and ligamentous reconstructive surgery the same day.  Subsequent right knee surgeries included:  loose body removal and lateral meniscus repair (August 2002); adhesion lysis and posterior capsular release (April 2003); and partial chondroplasty and coblation, partial medial removal, and hardware removal (April 2004).  
The 15 November 2003 MEB NARSUM examination, 9 months prior to separation, noted complaints of right knee pain and stiffness after a typical day at work.  Although he was able to fly his aircraft and bicycle without pain, the CI reported that pain limited his ability to function in his current work capacity.  Physical examination revealed mild instability with valgus laxity to 5mm and trace Lachman’s testing indicating a soft end point.  Range of motion (ROM) was flexion to 112 degrees (normal 140) and extension to 0 degrees (normal); painful motion, swelling, and meniscus testing were not addressed.  An orthopedic evaluation on 4 May 2004, 3 months before separation, showed “near” right knee ROM with painful motion, swelling, stability and meniscus testing not addressed. 

At the 3 August 2004 VA Compensation and Pension (C&P) general evaluation, 3 days after separation, the CI reported right knee pain with prolonged standing, walking or stair climbing.  Flare-ups occurred with hard-impact activities but he required no assistance devices. Physical examination revealed knee tenderness and positive patella testing for patellofemoral pain syndrome.  Flexion was to 95 degrees and decreased to 90 degrees after repetition, with painful motion present; extension was to 0 degrees.  X-rays revealed moderate knee osteoarthritic changes and moderate effusion. 

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the right knee condition 10%, coded 5260 (leg, limitation of flexion).  The PEB also listed “status post multiple reconstructions for posterolateral fracture dislocation of the right knee” as a related Category II condition (contributes to the primary unfitting condition but not separately ratable).  The VA rated the right knee condition 10%, analogously coded 5010-5260 (degenerative arthritis due to trauma-leg, limitation of flexion), based on the C&P evaluation, citing painful motion due to traumatic arthritis and limited motion.  Panel members first agreed that the impairment from the Category II condition was properly subsumed under the overall rating for the chronic right knee condition IAW §4.14 (avoidance of pyramiding; more than one rating based on the same impairment is prohibited).  The panel next noted no limitation of flexion or extension proximate to separation that supported a minimum rating under the VASRD diagnostic codes for limitation of motion (5260 or 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 recorded in the C&P evaluation most proximate to separation.  There was no evidence of significant lateral instability to support a 10% rating under the 5257 code (knee, other impairment).  Although there was a history of surgery to remove a meniscus (5259), the panel agreed that this pain symptom was already a component of the painful motion noted above, and if reapplied would be in violation of pyramiding IAW §4.14.  Similarly, although there was a fracture of the tibial plateau to support consideration under code 5262 (knee impairment related to long bone conditions), members agreed this too would be in violation of pyramiding.  After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the panel concluded there was insufficient cause to recommend a change in the PEB adjudication for the right knee condition.

Contended PEB Conditions:  Depressive Disorder and Anxiety Disorder.  The panel’s main charge is to assess the fairness of the PEB’s determination that the contended conditions were not unfitting.  There was no limited duty profile in evidence and the non-medical assessment only implicated the right knee condition, stating the CI was a “dedicated and shining example of a Marine Corps Officer.”  The CI also provided a memo to the PEB that documented his successful flight status return but acknowledged his right knee condition was duty limiting.  None of the contended conditions were judged to fail retention standards.  There was no psychiatric NARSUM evidence and the MEB did not forward a mental health diagnosis to the PEB.  The C&P psychiatric evaluation, 3 days after separation, noted absent or minimal symptoms.  Consequently, members agreed there was no performance-based evidence from the record that any of the contended conditions significantly interfered with satisfactory duty performance at separation.  After due deliberation, the panel concluded there was insufficient cause to recommend a change in the PEB fitness determination for any of the contended conditions and so no additional disability ratings are recommended.

BOARD FINDINGS:  In the matter of the chronic right knee pain condition and IAW VASRD §4.71a, the panel recommends no change in the PEB adjudication.  In the matter of the contended depressive disorder and anxiety disorder conditions, the panel agrees it cannot recommend additional disability ratings.  There were no other conditions within the panel’s scope of review for consideration.  Therefore, the panel 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 20160914, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs 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 USN
		- XXXXXXXXXXXXXXXXXX, former USMC
		- XXXXXXXXXXXXXXXXXX, former USMC
		- XXXXXXXXXXXXXXXXXX, former USMC
		- XXXXXXXXXXXXXXXXXX, former USMC
		- XXXXXXXXXXXXXXXXXX, former USN

					XXXXXXXXXXXXXXXXXX
	     				Acting