RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2016-01528
BRANCH OF SERVICE:  MARINE CORPS	SEPARATION DATE:  20040331

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E4, Assault Amphibious Vehicle Crewman, medically separated for “right knee pain” with a disability rating of 10%.  

CI CONTENTION:  “Knee issues (surgery), PTSD [and bilateral plantar fasciitis.]  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 it reasonably reflects the severity of the disability at the time of separation.  

RATING COMPARISON:  

SERVICE PEB - 20040126	VARD - 20050228	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Right Knee Pain	5299-5003	10%	Status Post Patellar Dislocation Surgery 	5257	10%	20050106	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  20%	

ANALYSIS SUMMARY:  

Right Knee Pain.  According to the service treatment record (STR) and Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI underwent arthroscopy and subsequent tibial tubercle osteotomy in February 2002 with hardware removal in July 2003.  The 4 November 2003 MEB NARSUM examination, 5 months prior to separation, noted complaints of right knee pain with any type of high impact activity such as running and jumping and also with kneeling and squatting.  There were no complaints of locking or giving way and no further dislocations were reported.  Physical examination revealed full knee range of motion (ROM).  There was tenderness over the prominent and proximal tibia and tibial tubercle.  There was no joint line tenderness.  Provocative testing revealed no laxity or instability.  
At the 6 January 2005 VA Compensation and Pension (C&P) evaluation, 9 months after separation, the CI reported pain with weight bearing activities.  Physical examination showed a normal gait.  There was tenderness at the patella.  ROM was flexion of 140 degrees (normal) and extension of 0 degrees (normal).  Painful motion was not reported and ROM was not additionally limited by pain, fatigue, weakness or lack of endurance.  The Drawer test on the right was abnormal with moderate instability.  Testing for meniscal pathology was negative.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the right knee condition 10%, coded 5299-5003 (analogous to degenerative arthritis) noting a 0% deduction for pre-existing disability.  The VA also rated the right knee condition 10%, coded 5257 (knee, other impairment of: recurrent subluxation or lateral instability), based on the C&P examination 9 months after separation, citing moderate laxity, but deducting for pre-existing disability.  

The panel adjudged that the MEB NARSUM examination had the highest probative value for rating at separation, due to its proximity to separation and alignment with the remainder of the STR evidence.  There was no limitation of motion which supported any rating higher than 10% 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 history of surgery to remove a meniscus (5259) to support a rating under those 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); although, given tibial tubercle surgery, alternative analogous rating was considered.  However, the panel adjudged that the CI’s disability did not more closely approximate the next higher 20% moderate knee disability picture at separation.  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 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.  Therefore the panel recommends that there be 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 20161008, 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:

		- 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 USMC
		- XXXXXXXXXXXXXXXXXX, former USMC
		- XXXXXXXXXXXXXXXXXX, former USMC
		- XXXXXXXXXXXXXXXXXX, former USMC
		- XXXXXXXXXXXXXXXXXX, former USN

		
							XXXXXXXXXXXXXXXXXX
	     				                                Acting