RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2016-01555
BRANCH OF SERVICE:  Marine Corps 	SEPARATION DATE:  20040505

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E4, Landing Support Specialist, medically separated for “left knee medial femoral condyle osteochondritis dissecans” with a disability rating of 10%.  

CI CONTENTION:  Requested review of her knee and an additional condition 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 - 20040202	VARD - 20050713	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Left Knee Medial Femoral Condyle Osteochondritis Dissecans (OCD)	5299-5003	10%	Osteochondral Defect with Medial Plica Status Post Arthroscopy with Excision of the Medial Plica and Microfracture… 	5014-5260	10%	20050527	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  10%	

ANALYSIS SUMMARY:  

Left Knee Medial Femoral Condyle OCD.  According to the service treatment record and MEB narrative summary (NARSUM), the CI underwent arthroscopic surgery for left knee femoral condyle OCD in 1997 and had a normal orthopedic examination with no symptoms in July 2000 prior to enlistment.  She began having left knee pain again in December 2001 without new trauma, and had a second left knee arthroscopic surgery for a microfracture of the recurrent OCD, and excision of a symptomatic plica (thickened area of the joint capsule).  She continued to have pain and there was no additional surgical indication.  

The 13 November 2003 MEB NARSUM examination, 6 months prior to separation, noted complaints of left knee pain with running more than one to two miles.  Physical examination showed left knee flexion to 140 degrees (normal) and extension to 0 degrees (normal).  

At the 27 May 2005 VA Compensation and Pension (C&P) evaluation, 13 months after separation, the CI reported left knee pain and weakness with walking and lifting, and worsened by running and going up or down stairs.  Physical examination showed normal gait, flexion to 140 degrees and extension to 0 degrees, without painful motion.  The examiner reviewed results of knee X-rays that reportedly show signs of osteoarthritis.  

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), citing full range of motion (ROM).  The VA also rated the OCD with medial plica status post arthroscopy and excision condition 10%, dual coded 5014-5260 (osteomalacia-leg, limitation of flexion), based on the C&P examination, citing X-ray evidence of arthritis and no compensable ROM limitation.  Members agreed there was no limitation of motion which supported a rating under the diagnostic codes for limitation of flexion or extension (5260, 5261) or evidence of painful motion with functional loss supporting a 10% rating (based on §§4.59, 4.40 and 4.45).  There was no history or evidence of dislocated meniscus or loose body causing frequent locking with recurrent effusions (5258).  The 5259 code (cartilage, semilunar, removal of, symptomatic) was not applicable in this case, and 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).  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.  

BOARD FINDINGS:  In the matter of the left knee medial femoral condyle OCD 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 20161018, 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 USN
		- XXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXX, former USMC
		- XXXXXXXXXXXXXXXXXX, former USMC
		- XXXXXXXXXXXXXXXXXX, former USMC
		- XXXXXXXXXXXXXXXXXX, former USMC
		- XXXXXXXXXXXXXXXXXX, former USN

							XXXXXXXXXXXXXXXXXX
	     				                        Assistant General Counsel
						           (Manpower and Reserve Affairs)