RECORD OF PROCEEDINGS PHYSICAL DISABILITY BOARD OF REVIEW
NAME:  XXXXXXXXXXXXXXXXXXXXXXX	CASE: PD-2017-02744
BRANCH OF SERVICE: MARINE CORPS	SEPARATION DATE: 20090227

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

CI CONTENTION:  No specific contention was made.  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 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 - 20081027	VARD - 20090417	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Joint Pain Localized to Right Knee	5099-
5003	10%	Degenerative Joint Disease, Right Knee and Femoropatellar Joint	5257	20%	20090417	
COMBINED RATING: 10%	COMBINED RATING OF ALL VA CONDITIONS: 70%	

ANALYSIS SUMMARY:

Right Knee Pain. According to the service treatment record (STR) and MEB narrative summary (NARSUM), the CI’s knee condition began in January 2005 when he was hit with a piece of artillery shell during combat and removed an approximately one half inch by one inch shrapnel fragment himself. Despite approximately 2 years of therapy and modified activities he continued to have right knee symptoms that impaired the performance of his duties. Multiple examinations in the STR from 22 February 2007 to separation showed no evidence of ligamentous instability or meniscal pathology. An MRI of the right knee completed on September 2006 revealed posterior tibial plateau edema and edema behind the kneecap due to trauma or patellar mal-tracking, and no evidence of cartilage injury. Knee X-rays done in June 2005, May 2006, and April 2008 all indicated a normal right knee.

The 10 September 2008 sports medicine addendum, 6 months prior to separation, noted complaints of persistent intermittent right knee pain for nearly 4 years. The CI reported swelling and giving way, without crepitus or locking.     He reported his knee condition had no significant

effect on his daily activities, but it significantly affected his job as he was unable to run or deploy. Physical examination showed no gait disturbance. There was no deformity, edema, or effusion. Active range of motion (ROM) showed extension was normal and flexion was 115 (140 normal) with pain at full flexion. There was diffuse anterior patellar pain. Right knee strength was full and the CI was able to heel and toe walk. There was no evidence of instability or meniscal pathology. There was no joint line tenderness. There was a negative apprehension sign and negative patellar grind test. Testing for pain in the patellofemoral joint was positive (positive patellar compression). The MEB NARSUM examination noted complaints of intermittent anterior right knee pain that worsened with running and prolonged sitting or standing and instability. Physical examination revealed tenderness of the right knee along the medial patella and normal strength.

At the 17 April 2009 VA Compensation and Pension (C&P) examination, 2 months after separation, the CI reported a right knee anterior pain, weakness, easy fatigability, pain, and impairment of coordination. He reported that with medication he could function with the pain. On physical examination there was a .5 cm by 6 cm scar at the level of the knee that was not tender or adherent. Right knee extension was normal and flexion was 120 degrees after repetitive testing, limited by muscle weakness and decreased endurance. The anterior and posterior cruciate ligaments stability test of the right knee was abnormal with severe instability. The medial and lateral collateral ligaments stability test of the right knee was abnormal with moderate instability. The medial and lateral meniscus test of the right knee was abnormal with moderate degree of severity. The CI walked with a right-sided limp. The VA examiner stated the muscle group involved was XII (anterior muscles of the leg), the muscle strength was graded 4/5. The examiner indicated there was a muscle wound present medial to the right patella. There was no loss of deep fascia, muscle substance or impairment of muscle tone. There was no intramuscular scarring. The examiner indicated the muscle injury involved injury to the infrapatellar tendon, without involving bone, joint, or nerve damage. Right knee X-rays showed mild degenerative changes. Outpatient VA treatment notes indicated the CI was evaluated for his right knee pain by MRI in mid-May 2009, 3 months after separation, and a right medial meniscal tear was found. He underwent an arthroscopy in June 2009 (documentation not in record) and did well for approximately the next year.

The panel directed attention to its rating recommendation based on the above evidence. The PEB rated the knee condition 10%, analogously coded 5099-5003 (degenerative arthritis), citing painful motion. The VA rated the knee condition 20%, coded 5257 (knee, other impairment), based on the C&P examination citing moderate right knee instability. There was no limitation of motion which supported a rating under the diagnostic codes for limitation of flexion or extension (5260, 5261). However, there was evidence of painful motion with functional loss supporting a 10% rating (based on §§4.59, 4.40 and 4.45). The VA examiner documented criteria for alternatively rating the CI’s shrapnel injury as a muscle condition, however, the panel agreed the evidence supports no higher than a 0% rating for slight muscle injury, coded 5311 (includes knee flexion) IAW VASRD §4.73. Although the VA examination reported instability, an MRI performed one month later noted a meniscal tear for which the CI underwent arthroscopic surgery and no other abnormality was noted in record. There was therefore no higher than a 10% rating supported under any applicable code. 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 knee condition.

BOARD FINDINGS:        In the matter of the joint pain localized to the right knee 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 20170218, w/atchs Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Record

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 29 Oct 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 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.