RECORD OF PROCEEDINGS PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXXXX		CASE: PD-2017-01139 BRANCH OF SERVICE: MARINE CORPS	SEPARATION DATE: 20050715

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

CI CONTENTION: The CI had continued problems with the right knee. He also requested review of 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 - 20050503	VARD - 20060215	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Status Post Right ACL Reconstruction	5099-5003	10%	Right Knee ACL and Meniscus Repair	5259	0%	STR	
Status Post Medial Meniscus Repair	Cat II					
COMBINED RATING: 10%	COMBINED RATING OF ALL VA CONDITIONS: 0%	

ANALYSIS SUMMARY:

Status Post Right Anterior Cruciate Ligament (ACL) Reconstruction. According to the service treatment record (STR) and MEB narrative summary (NARSUM), the CI’s right knee pain condition began in December 2003 after twisting it on the obstacle course. In April 2004 he underwent ACL reconstruction surgery with a hamstring autograft and a bucket handle meniscus tear repair. The CI participated in physical therapy and regained full motion but still had pain and instability.

The 7 March 2005 MEB NARSUM examination, 4 months prior to separation, noted complaints of pain with stairs and running with some persistent swelling.  He reported some instability and

knee “wobbles” when he was fatigued. Physical examination of the right knee showed well- healed wounds; range of motion was flexion 130 degrees (normal 140) and extension 0 degrees (normal). He had trace effusion and decreased sensation in the anterior tibia distal and lateral to incision. Lachman’s test was grade I with solid end point. He was stable to varus and valgus stresses.  There was no VA examination proximate to separation in evidence.

The panel directed attention to its rating recommendation based on the above evidence. The PEB rated the right knee condition 10%, analogously coded 5099-5003 (arthritis, degenerative). The VA rated the knee condition 0%, coded 5259 (cartilage, semilunar, removal of, symptomatic), based on the STR, citing service connection but CI failed to report to scheduled VA examination.

There was no limitation of motion which supported a rating under the diagnostic codes for limitation of flexion or extension (5260, 5261). There were reports of pain and swelling with use and evidence of effusion with functional loss supporting a 10% rating (based on §4.40 and §4.45). There was no 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). No additional functional limitation was evidenced by the examinations. There is therefore no VASRD §4.71a higher rating option than the 10% adjudicated by the PEB under any applicable code.

The PEB listed medial meniscus repair as a related diagnosis (Category II) contributing to the disability in this case. The panel noted that pain and swelling were the primary symptoms associated with meniscal pathology; therefore, it contributed to the disability and could not be reasonably justified as separately unfitting without speculation. Additionally, separate ratings would not be achievable without violation of VASRD §4.14 (avoidance of pyramiding). After due deliberation, considering all 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 pain condition.

BOARD FINDINGS: In the matter of the right knee pain 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.

DEPARTMENT OF THE NAVY
SECRETARY OF THE NAVY COUNCIL OF REVIEW BOARDS 720 KENNON STREET SE STE 309
WASHINGTON NAVY YARD, DC 20374-5023

IN   REPLY  REFER  TO:
1850
CORB: 003 20May20

From: 

Director, Secretary of the Navy Council of Review Boards 

Subj:  PHYSICAL  DISABILITY  BOARD OF REVIEW (PDBR)

Ref:	(a) DoDI 6040.44
(b) PDBR ltr dtd 21 Sep 18

1.	Pursuant to reference (a), the PDBR reviewed your case and forwarded its recommendation (reference (b)) to the Department of the Navy on 5 Mar 2020 for appropriate  action.

2.	On 20 March 2020, the Assistant Secretary of the Navy (Manpower & Reserve Affairs) accepted the recommendation of the PDBR ofno change to your characterization of separation or disability rating assigned by the Department of the Navy's Physical Evaluation  Board.

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.