RECORDOF PROCEEDI N GS PHYSICAL DISABILITY BOARDOF REVIEW

N AME:XXXXXXXXXXX
BRANCH OF SERVICE: M ARINE CORPS

CASE: PD-2017-00206 SEPARATION DATE: 20030415

SUM M ARY OF CASE: Data ext racted fr om the available evidence of record refl ect s this cove red individual (Cl) was an active dut y E4, Ground Radio Operato r, medically separat ed for "funct ional anterior cruciat e ligament [ACL] insuff iciency stat us post [s/p] left knee ACL r eco nstruct ion" wit h a disability rating of 10%.

Cl CONTENTOI N:   Rev iew  r eq u ested for  a higher rating to  include multiple  left  and  right  knee issues. The complete subm ission is at Exhibit A.

SCOPE OF REVIEW: The panel's scope of rev iew is defined in DoDI 6040.44. It is limited to review of disability ratings assigned t o those condit ions dete rm ined by the Physical Evaluat ion Board (PEB) to be unfi tt ing for continued milit ary service, and whe n specificall y requested by the Cl, those condit ions identified by the Medical Evaluat ion Board (M EB), but determined by the PEB to be not unfi tt ing or non -compensable. Any conditions out side t he panel's defined scope of review, and any contention not requested in th is application, may remain eligible for future consideration by t he Board for Corr ection of M ilit ary Records. The panel' s authority is limited to assessni g the fairness and accuracy of PEB rat ing dete rmi nat ions and recommending corrections whe n appropriat e. The panel' s assessment of the PEB r ating determinat ion is based on rev iew of medical records and all available evidence relevant to  applicat ion of  the Vet erans Affairs Sch edule for Rat ing Disabilit ies (VASRD) st andards for the unfitt ing medical condit ion(s) at the time of separation. The panel has neither the role nor the authority to compensat e for post­ separat ion progression or complications of service -connected condit ions; t hat role and authority is granted by Congr ess to the Depart ment of Veterans Aff air s, which operates under a diff erent set of laws. The panel gives consideration t o VA evidence, part icularly with in 12 months of separat ion, but only to the extent that it reasonab ly reflects the severity of disability at the t ime of separat ion.

RATINGCOM PARISON:

SERVICE PEB • 20030 212	VARD • 20040301	
Condition	Code	Ratine	Condition	Code	Ratine	Exam	
Function al ACL Insufficiency S/P Left Knee ACL Reconst ructi on	5299-5003	10%	S/P ACL Reconstr uct io n (Left Knee)	5 257	20%	20030809	
S/P M edial and Later al
Meniscectom ies	Cat II	No VA Placement	
Right Knee Patellofe moral Syndr ome	
Cat Ill	Patellofe moral Crepitu s, Right Knee	
5014-5260	
10%	
20030809	
COM BINEDRATING: 10%	COM BINED RATING OF ALL VA CONDITIONS: 50%	

ANALYSIS SUM M ARY:

Left Knee ACL Insuffi ciency.	According to the service tr eatment record and MEB narrative summary (NARSUM ), the Cl's left knee condit ion began in Oct ober 2000 aft er sustaining an inj ury

while playing football. An MRI on 30 May 2001 showed an ACL tear, and on 16 August 2001 the he underwent ACL reconstructive surgery. After a course of physical therapy, he continued to have pain, and in May 2002, he had a left knee partial medial meniscectomy with removal of loose hardware. In October 2002, the CI re-injured the left knee and underwent a partial lateral meniscectomy on 30 October 2002.

At the CI’s third limited duty (LIMDU) medical board on 24 September 2002, 7 months before separation, he reported bilateral knee pain with increasing right knee pain, particularly with therapy. On physical examination, there was “positive joint line tenderness with positive compression signs [no mention of which knee or both].” The final diagnoses were “s/p left knee ACL reconstruction,” “s/p left knee arthroscopy with medial meniscal debridement,” and “probably medial meniscus right knee.” The board found the CI not fit for full duty but recommended an additional LIMDU period of 6 months. Continued left knee rehabilitation and a full right knee work-up with arthroscopy and meniscectomy was recommended.

A 17 October 2002 addendum to the LIMDU board findings, 6 months prior to separation, was accomplished for the diagnosis of “left knee ACL tear” after the CI reported a re-injury on 15 October 2002 when he crouched down. Upon standing, he felt a sharp pain on the lateral aspect of the knee and subsequently had new popping and catching. Physical examination showed lateral joint line tenderness exacerbated by Apley’s compression testing.

At the 12 January 2003 MEB NARSUM examination, 3 months before separation, the CI complained of global left knee pain with a sensation of instability. Physical examination showed range of motion (ROM) from 0 degrees (normal) extension to 135 degrees (normal 140) flexion, and a 5-mm anterior translation with firm endpoint. There was no pain or instability noted with valgus or varus stress testing.

At the 9 August 2003 Compensation and Pension (C&P) examination, 4 months after separation, the CI reported chronic pain and effusion with instability and giving way approximately 1-2 times per week. The instability was worsened by going up and down stairs, and he wore a knee brace with any type of strenuous activity. Physical examination revealed well-healed surgical scars and immediate decreased sensation around all of the scars. There was normal sensation distally in the left lower extremity. Lachman’s testing showed definite 2B grade instability and McMurray’s testing revealed medial joint line tenderness and pain. There was also an audible and palpable click when the left knee was flexed greater than 130 degrees, but strength was normal during flexion and extension. A patellar grind test was negative.
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 listed “s/p medial and lateral meniscectomies” as a Category II condition (contributes to the unfitting condition but not separately ratable). The VA rated the left knee condition 20%, coded 5257 (knee, other impairment of: recurrent subluxation or lateral instability moderate), citing recurrent pain and instability status post left ACL reconstruction. Members noted that the PEB’s adjudication of the left knee pain at 10% also referenced a degree of ACL instability factored into the disability rating. The VASRD allows for dual rating of the knee for both pain and instability separately, however, while instability was documented, multiple examiners noted a firm endpoint or stable ACL findings. The panel observed that multiple treatment notes recorded left knee pain as the primary factor impacting the CI’s inability to perform his duties. The panel noted that the PEB rated the condition analogously to 5003 (degenerative arthritis with non- compensable limitation of motion and pain in a major joint) versus the instability code 5257. The panel also noted that the “left knee status post medical and lateral meniscectomies” condition, for which the primary symptom was pain, was adjudicated as a Category II condition contributing to the unfitting condition. Panel members concluded the dominant disabling symptom adjudicated by the PEB was left knee pain and that left knee instability could not be reasonable

justified as separately unfitting for dual rating under 5257. After due deliberation, considering all 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 left knee condition.

Contended PEB Condition: Right Knee Patellofemoral Syndrome. The panel’s main charge is to assess the fairness of the PEB determination that the contended condition was not unfitting. The contended condition was listed by the 24 September 2002 LIMDU board as “bilateral knee pain.” Additionally, the MEB NARSUM cited that the final evaluation by orthopedics on 10 January 2003 included re-evaluation for “left and right knee pain.” The right knee condition was not specifically implicated in the non-medical assessment and there was no performance-based evidence from the record that the condition significantly interfered with satisfactory duty performance at separation. After due deliberation, the panel concluded there was insufficient cause to recommend a change in the PEB fitness determination for the contended condition, so no additional disability rating is recommended.

BOARD FINDINGS: In the matter of the left knee condition and IAW VASRD §4.71a, the panel recommends no change in the PEB adjudication. In the matter of the contended right knee condition, the panel recommends no change from the PEB determination as not unfitting. 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:

DEPARTMENT OF THE NAVY
SECRE1'ARY OF TilE NAVY COUNCIL OF REVIEW BOARDS 720 KENNON STREET SE STE 309
WASHUIGTON NAVY YARD, DC 20374· 5023

Ill Rt PLY R!,l'ER TO,
1850
CORB: 003
10 Sep 20

From: Director, Secretary of the Navy Council of Review Boards To:
Subj: PHYSICAL DISABILITY BOARD OF REVIEW (PDBR) Ref:	(a) DoDI 6040.44
I. Pursuant to reference (a), the PDBR reviewed your case and forwarded its recommendation to
the Department of the Navy on 13 Aug 2020 for appropriate action.

2.	On 27 August 2020, the Assistant Secretary of the Navy (Manpower & Reserve Affairs) accepted the recommendation of the PDBR of no change to your characterization of separation or disability rating assigned by the Department of the Navy's Physical EvaluationBoard.

3.	The Secretary's decision on your PDBR application is final and is not subject to appeal or additional review by the Board for Correction of Naval Records.