RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2016-01117
BRANCH OF SERVICE:  Marine Corps	SEPARATION DATE:  20040331

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E5, Aircraft Maintenance Ground Support Equipment Hydraulic/Pneumatic Structures Mechanic, medically separated for “right knee osteochondral defect, status post chondroplasty” 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 - 20040209	VARD - 20040920	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Right Knee Osteochondral Defect, Status Post Chondroplasty	5299-5003	10%	Arthroscopic Chondroplasty for Removal of Loose Body, Right Knee Osteochondral Defect	5299-5259	10%	STR	
Right Knee Loose Body, Status Post Surgical Excision	Cat II					
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  10%	

ANALYSIS SUMMARY:  

Right Knee Osteochondral Defect, Status Post Chondroplasty.  According to the service treatment record (STR) and MEB narrative summary (NARSUM), the CI underwent right knee surgery in July 2003 for knee pain and locking symptoms.  Arthroscopic surgery included excision of a loose body and repair (microfracture) of a lateral femoral condyle osteochondral defect, as previously noted on diagnostic imaging.  The CI received physical therapy and limited duty, but was unable to return to a full duty status.  At the primary care clinic visit on 8 November 2003, 4 months prior to separation, the CI complained of daily knee pain.  Physical examination showed full range of motion (ROM), good stability, and tenderness to palpitation.  The 5 December 2003 MEB NARSUM examination, 3 months prior to separation, noted complaints of right knee pain.  Physical examination showed ROM of 0 degree extension (normal 0) and 120 degrees flexion (normal 140) with crepitus.  There was some tenderness over the lateral femoral condyle consistent with the area of the repaired osteochondral defect.  The knee was stable to anterior, posterior, varus, and valgus testing.  His lower extremity and foot were neurovascularly intact.  During the 8 January 2004 MEB examination (recorded on DD Forms 2807-1 and 2808), 2 months prior to separation, the CI reported his right knee swelled up during physical training and was painful with running.  The right knee would give out when going up steps or squatting.  Physical examination showed decreased strength to the right leg (2/5) due to knee pain.  There was no VA examination proximate to separation in evidence.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the right knee osteochondral defect, status post chondroplasty condition 10%, analogously coded 5299-5003 (arthritis, degenerative).  The VA rated the right knee condition 10%, analogously coded 5299-5259 (cartilage, semilunar, removal of, symptomatic), based on the STR, citing symptomatic removal of the semilunar cartilage.  The PEB’s Category II diagnosis (right knee loose body, status post surgical excision) is intrinsic to the rated condition and a separate rating cannot be supported without pyramiding (VASRD §4.14); thus, it is appropriately subsumed under the same rating.  

There was no limitation of motion which supported a rating under the diagnostic codes for limitation of flexion or extension (5260, 5261).  There was no history or evidence of dislocated meniscus or loose body causing frequent locking with recurrent effusions (5258).  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).  There was therefore no higher rating than 10% available under any applicable VASRD code.  After due deliberation, considering all 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 pain condition.  

BOARD FINDINGS:  In the matter of the right knee (osteochondral defect, status post chondroplasty and category II loose body, status post surgical excision) condition and IAW VASRD §4.71a, the panel recommends no change in the PEB adjudication.  There are 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 20160915, 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 USN
		- XXXXXXXXXXXXXXXXXX, former USMC
		- XXXXXXXXXXXXXXXXXX, former USMC
		- XXXXXXXXXXXXXXXXXX, former USMC
		- XXXXXXXXXXXXXXXXXX, former USMC
		- XXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXX, former USMC
		- XXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXX, former USMC
		- XXXXXXXXXXXXXXXXXX, former USMC

							XXXXXXXXXXXXXXXXXX
	     				                        Assistant General Counsel
						        (Manpower and Reserve Affairs)