RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX 	CASE:  PD-2016-01760
BRANCH OF SERVICE:  MARINE CORPS 	SEPARATION DATE:  20041215 

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E6, Ground Data/Communications Maintenance Technician, medically separated for “osteoarthrosis left knee” with a disability rating of 20%.  

CI CONTENTION:  Condition continues to worsen, and he contends for conditions not listed on 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 – 20041022 	VARD – 20050207 	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Osteoarthrosis Left Knee	5299-5257	20%	Status Post Left Knee Meniscectomy and Anterior Cruciate Ligament (ACL) Reconstruction	5299-5260	10%	20041108 	
COMBINED RATING:  20%	COMBINED RATING OF ALL VA CONDITIONS:  30%	

ANALYSIS SUMMARY:  

Osteoarthrosis Left Knee.  According to the service treatment record and the MEB NARSUM, the CI underwent left knee surgery in April of 2003 for anterior cruciate ligament (ACL) reconstruction using patellar tendon autograft and debridement of a significant tear of the meniscus.  Standing radiographs revealed significant signs of arthritis of the left knee when compared to the right knee.  

At the 18 September 2004 MEB NARSUM, 3 months prior to separation and 17 months after surgery, the CI continued to have significant pain in his left knee with stiffness.  He was unable to run and had significant pain when he attempted to kneel or climb stairs.  Physical examination showed a normal gait.  Valgus stress testing noted instability at 30 degrees, but varus stress testing at 0 and 30 degrees were both normal.  The range of motion (ROM) was normal, and other tests for instability were negative.  During the 5 October 2004 MEB examination (recorded on DD Forms 2807-1 and 2808), 2 months prior to separation, physical examination showed the CI was wearing a knee brace secondary to knee instability, and he had an incisional scar due to his arthroscopic surgery.  

At the 8 November 2004 VA Compensation and Pension (C&P) evaluation, 1 month before separation, the CI reported running, jumping or kneeling and standing for long periods of time caused him pain.  The left knee ROM following repetitive movement was flexion to 120 degrees (normal 140) and extension to 0 degrees (normal) with pain at the extremes.  Tests for instability were within normal limits with the exception of the drawer test (ACL stability), which was slightly positive.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the left knee condition 20%, coded analogously to 5257 (knee, other impairment of:  recurrent subluxation or lateral instability).  The VA rated the left knee condition 10%, coded analogously to 5260 (leg, limitation of flexion of), citing decreased range of motion with pain on flexion at 120 degrees.  

The persistence of pain after meniscal surgery warranted a 10% rating under the 5259 code (cartilage, semilunar, removal of symptomatic).  There was no limitation of motion (5260, 5261), and no history of dislocated meniscus or loose body causing frequent locking with recurrent effusions (5258) to support a rating under this code.  There was likewise no fracture, nonunion or malunion of the femur or tibia to support consideration under the codes for knee impairment related to long bone conditions (5255, 5262).  In deliberating a rating under the 5257 code (knee, other impairment of; recurrent subluxation or lateral instability), as adjudicated by the PEB, the panel considered use of knee brace and noted the objective examination findings by orthopedic and NARSUM examiners of lateral instability were no more than mild.  The panel agreed this evidence most accurately described “slight” instability under the 5257 code.  After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the panel recommends a separation rating of 10% for symptomatic cartilage removal coded 5259, and 10% for lateral knee instability coded 5257, for a combined rating of 20% for the left knee condition.  Panel members noted this did not constitute a rating advantage for the CI.  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 osteoarthrosis left 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 20161017, 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 USN
		- XXXXXXXXXXXXXXXXXX, former USMC
		- XXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXX, former USMC

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	     				                        Acting