RECORD OF PROCEEDINGS PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXXXXXX		CASE: PD-2017-01200 BRANCH OF SERVICE: MARINE CORPS	SEPARATION DATE: 20091230

SUMMARY OF CASE: Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E3, Basic Marine, medically separated for “right knee medial meniscal tear” with a disability rating of 10%.

CI CONTENTION: “Rating did not include all medical issues related to service.” 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 Medical Evaluation Board (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 – 20091106	VARD - 20100624	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Right Knee Medial Meniscal Tear	5259	10%	Right Knee Medial Meniscal Tear Status Post (S/P) Meniscectomy	5259	10%	20100524	
COMBINED RATING: 10%	COMBINED RATING OF ALL VA CONDITIONS: 10%	

ANALYSIS SUMMARY:

Right Knee Medial Meniscal Tear. According to the service treatment record (STR) and Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s right knee condition began in the summer of 2009 after twisting her knee during boot camp. An MRI done on 21 September 2009 showed a “peripheral tear of the body and posterior horn of the medial meniscal, extending into the inferior articular surface. Otherwise, unremarkable MRI.” At the 28 September 2009 physical therapy clinic appointment on, 3 months prior to separation, the examiner recorded the CI had tenderness in her right knee.  There was pain with motion, and positive McMurray and   Apley’s

compression tests. There was no effusion, erythema, warmth, deformity, or crepitus noted. The examiner documented that the “knee did not show full range of motion (ROM).” There was no medial instability. Lachman’s and apprehension tests were negative and there was no tenderness with ambulation. During the MEB NARSUM examination the next day the CI denied any mechanical or instability symptoms or effusion, but did report continued medial joint line pain. She noted her pain worsened with activity, especially with running and any pivoting type maneuvers. She refused arthroscopic surgery which the examiner noted was not unreasonable. Physical examination revealed the CI was in no acute distress and had a normal gait. There was no knee deformity, edema, erythema or effusion. She was intact neurovascularly. The right knee flexion measured 0-130 degrees (normal 140). There was some medial joint line tenderness, and pain at full extension and with Murray’s testing. The patellar compression apprehension tests were negative. There was no quadriceps atrophy. The final diagnosis was right knee medial meniscal tear.

Three month after separation, on 30 March 2010, the CI underwent a right knee scope, partial medial meniscectomy, and medial debridement surgery. At the orthopedic surgery follow-up appointment 2 weeks later, the examiner noted the CI was having more pain S/P surgery than pre-operatively. She had been on her feet working up to 3 hours at a time. Physical examination showed good motion and no effusion. She was advised to refrain from working and putting unnecessary stress on her knee.

At the 24 May 2010 Compensation and Pension (C&P) examination, 5 months after separation, the CI reported pain noted in the posterior toward medial and along the joint line toward the distal patella. She stated that it felt as though it might pop out at any time. She reported weakness and heat. Her pain was characterized at a 4/10 upon waking up in the morning with flares of 7/10 one to two times per week lasting up to 2 hours. Alleviating factors were ice, elevation and rest. She had a normal gait and used no assistive devices for ambulation. The physical examiner noted she “essentially” had normal ROM. The kinesiotherapist ROM measurements were 0-145 degrees flexion followed by 96 degrees and 94 degrees with repetition, and 145-0 degrees extension and 10 degrees with repetition; no pain was noted with measurements. There was no heat, redness, erythema, effusion, edema, or instability weakness, and no guarding of movement. There was mild tenderness in the medial distal patella and medial posterior knee. There was no atrophy of the quadriceps muscles. Deep tendon reflexes were symmetrical and she had negative compression, collateral ligament, McMurray’s and Drawer’s tests.

At the 2 November 2010 VA C&P examination, 10 months after separation, the CI reported continued daily right knee pain. She characterized the pain as a 3-4/10. During daily flare-ups that were 6-7/10 she would elevate her legs and sit down to alleviate the pain. At this point she reported patella dislocations and subluxations two times per week and that her knee would lock up several times per day. She also reported daily swelling at the end of the day but no redness. Physical examination revealed slight swelling in the anterior inferior knee area and anterior medial. Ligament stressing showed all four ligaments intact, but with complaints of tenderness on medial and lateral ligament stretching. Her right knee ROM was measured as 0-145 degrees but decreased to 110 and 106 degrees on repetition. Extension was 145-0, followed by 10 on repetition.  She had a normal gait.

The panel directed attention to its rating recommendation based on the above evidence. The PEB and the VA rated the right knee condition 10%, coded 5259 (cartilage, semilunar, removal of, symptomatic). The VA cited symptomatic removal of the semilunar cartilage without locking or effusion. The panel noted there was no limitation of motion which supported a rating under the diagnostic codes for limitation of flexion or extension (5260, 5261). The persistence of pain after meniscal surgery warranted a 10% rating under the 5259 code which was applicable in this case, but the maximum 10% rating under that code provided no benefit to the CI.  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). There was therefore no VASRD §4.71a rating higher than the 10% adjudicated by the PEB under any applicable code.

BOARD FINDINGS: In the matter of the right 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.

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 <ltd 14 Mar 19

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 of no 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.