RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2016-01449
BRANCH OF SERVICE:  MARINE CORPS	SEPARATION DATE:  20040409

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E6, Machine Gunner, medically separated for “bilateral anterior cruciate ligament tear, status post reconstruction, with degenerative joint disease right knee” rated 10% for each knee, with a combined disability rating of 20%.  

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 - 20031106	VARD - 20050422	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Left Knee Anterior Cruciate Ligament Tear Status Post Repair	5299-5003	10%	Left Knee Instability; Status Post Anterior Cruciate Ligament Repair	5299-5257	10%	20040617	
Right Knee Anterior Cruciate Ligament Tear… with Degenerative Joint Disease	5299-5003	10%	Right Knee Instability; Status Post Right Anterior Cruciate Ligament Repair	5299-5257	30%	20040617	
Status Post OATS Procedure	Cat II					
COMBINED RATING:  20%	COMBINED RATING OF ALL VA CONDITIONS:  40%	

ANALYSIS SUMMARY:  

Left Knee Anterior Cruciate Ligament (ACL) Tear, Status Post (S/P) Reconstruction.  According to the service treatment record (STR) and MEB narrative summary (NARSUM), the CI’s left knee condition began in 1997 after a basketball injury.  He underwent a left ACL reconstruction in 2001 but continued to complain of knee pain and remained on activity limiting profiles.  
The 23 May 2003 MEB NARSUM examination, 11 months prior to separation, noted CI complaints of left knee pain.  Physical examination showed full range of motion (ROM) and X-rays revealed a bone-patella tendon-bone graft in place with two titanium screws, which appeared to be well positioned.  

At the 17 June 2004 VA Compensation and Pension (C&P) evaluation, 2 months after separation, the CI reported chronic aching and the inability to walk very far without marked knee discomfort and moderate swelling off and on.  Physical examination revealed crepitus with swelling and negative McMurray testing (for meniscus injury).  Knee ROM was flexion to 140 degrees (normal) and extension to 0 degrees (normal), with no limitation due to by pain, fatigue, weakness, or lack of endurance after repetition.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the left knee condition 10%, coded 5299-5003 (analogous to degenerative arthritis).  The VA also rated the left knee condition 10%, coded 5299-5257, (analogous to knee, other impairment of:  recurrent subluxation or lateral instability), based on the C&P examination citing slight, recurrent subluxation or lateral instability of the knee.  Members noted 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) or removal of a meniscus (259) to support a rating under the respective codes.  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 VASRD §4.71a 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 there was insufficient cause to recommend a change in the PEB adjudication for the left knee condition.  

Right Knee ACL Tear, S/P Reconstruction, with Degenerative Joint Disease.  According to the STR and MEB NARSUM, the CI’s right knee condition also began in 1997 after a basketball injury.  In March 2002, he underwent a right ACL reconstruction, an osteochondral allograft transplantation surgery (OATS) to replace damaged cartilage with healthy cartilage from a donor site, and a partial medial and lateral meniscectomy.  The CI continued to have knee pain and remained on activity limiting profiles.  At the primary care clinic visit on 7 March 2003, 13 months prior to separation and 12 months after surgery, the CI reported continued aching pain after running but denied any giving way of the knee.  Physical examination showed no effusion and good motion.  The 23 May 2003 MEB NARSUM examination, 11 months before separation, noted complaints of right knee pain with high-loading activities and an inability to run.  Physical examination showed no effusion and full knee ROM.  X-Rays showed appropriately placed bone tunnels without evidence of arthritis.  

At the 17 June 2004 C&P evaluation, 2 months after separation, the CI reported the same issues with his right knee as his left and physical examination revealed crepitus with swelling and negative McMurray testing.  Knee ROM was flexion to 120 degrees and extension 0 degrees.  The knee was not limited by pain, fatigue, weakness or lack of endurance after repetition.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the right knee condition 10%, analogously coded 5299-5003 (arthritis, degenerative).  The PEB listed the status post OATS procedure condition as a related diagnosis (Category II) that contributed to the disability in this case.  The VA rated the right knee condition 30%, analogously coded 5299-5257 (knee, other impairment of: recurrent subluxation or lateral instability), based on the C&P evaluation citing severe, recurrent subluxation or lateral instability of the knee.  Members first agreed that the OATS procedure was a diagnosis related to the Cat I unfitting condition and was not a separate condition which could be separately rated IAW §4.14 (avoidance of pyramiding; more than one rating based on the same impairment is prohibited).  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) to support a rating under that code.  There was a history of removal of a portion of the semilunar cartilage (meniscus) which continued to be symptomatic to justify a 10% rating under code 5259.  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 VASRD §4.71a 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 there was insufficient cause to recommend a change in the PEB adjudication for the right knee condition.  

BOARD FINDINGS:  In the matter of the bilateral knee 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 20161010, 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