RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2016-01234
BRANCH OF SERVICE: MARINE CORPS	SEPARATION DATE:  20040515

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects this covered individual (CI) was a Reserve E3, Rifleman, medically separated for “left knee patellofemoral syndrome (PFS)” with a disability rating of 10%.

CI CONTENTION:  Review of all conditions requested to include additional conditions not identified by the Medical Evaluation Board (MEB) and Physical Evaluation Board (PEB). 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 PEB to be unfitting for continued military service, and when specifically requested by the CI, those conditions identified by the 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 - 20040322	VARD - 20050803	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Left Knee PFS	5299-5003	10%	Remote Left Knee Injury Status Post Arthroscopic Surgery	5260	30%	20050718	
Partial Anterior Cruciate Ligament Tear	Cat II					
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  40%	

ANALYSIS SUMMARY:

Left Knee PFS.  According to the service treatment record (STR) and MEB narrative summary (NARSUM), the CI’s left knee condition began in January 1997 when he struck his knee to the ground after rappelling down a rope during boot camp.  The CI underwent left knee surgery in May 2001 for an anterior horn of the medial meniscus, subtotal synovectomy.  The 10 December 2003 MEB NARSUM examination, 5 months prior to separation, noted full left knee range of motion (ROM), tenderness, and positive patellar tilt and grind tests (for potential kneecap cartilage deterioration).  Left knee instability testing was negative.  
During the 21 February 2004 MEB examination (recorded on DD Forms 2807-1 and 2808), 3 months prior to separation, the CI reported continued left knee pain.  Physical examination showed left knee extension to 10 degrees; painful motion was not addressed.  There was some left knee medial laxity pain upon palpation of the knee; however, actual instability was not defined.

At the 18 July 2005 VA Compensation and Pension (C&P) examination, 14 months after separation, the CI reported intermittent left knee pain with recurrent swelling and the knee giving way.  He reported intermittent use of a knee brace.  Physical examination showed a slow but normal gait.  There was no left knee swelling or redness, but tenderness was evident.  Instability testing was negative.  Extension was 0 degrees (normal) and flexion 100 degrees (normal 140) with painful motion.

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the left knee condition 10%, analogously coded 5299-5003 (degenerative arthritis).  The PEB also listed partial anterior cruciate ligament (ACL) tear status post arthroscopy with continued pain as a related Category II condition (contributed to the unfitting condition but was not separately ratable).  The VA rated the left knee condition 30%, coded 5260 (leg, limitation of flexion), based on the C&P examination, citing limited ROM.

The panel agreed there was no limitation of motion which supported a rating under the diagnostic codes for limitation of flexion or extension (5260, 5261); based on the totality of the STR and VA records.  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).  The panel noted there was a history of surgery to remove a meniscus (5259) to support a 10% rating under that code; however, this offered the CI no rating advantage.  

In deliberating a rating for the PEB’s Category II diagnosis of the partial ACL tear status post arthroscopy with continued pain, the panel considered the CI’s intermittent knee brace usage and found no objective evidence of instability proximate to separation.  Panel members agreed there was no evidence of left knee instability to support an additional rating under code 5257.  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 left knee PFS.

BOARD FINDINGS:  In the matter of the left knee PFS 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 20160923, 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 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