RECORD OF PROCEEDINGS PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXXXXXXX		CASE: PD-2017-03036 BRANCH OF SERVICE: MARINE CORPS	SEPARATION DATE: 20081030

SUMMARY OF CASE: Data extracted from the available evidence of record reflects this covered individual (CI) was a Reserve E4, Field Radio Operator, medically separated for “status post left anterior cruciate ligament [ACL] reconstruction, with persistent pain,” with a disability rating of 10%.

CI CONTENTION:  “Review all conditions.” 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 - 20080620			VARD -	
Condition	Code	Ratin			Conditio	Code	Rating	Exam	
Status Post Left (ACL) Reconstruction	5299-5003	10%			Residuals of Left Knee ACL Tear and Surgery	5259	10%	20090112	
COMBINED RATING: 10%			COMBINED RATING OF ALL VA CONDITIONS: 10%	
	
ANALYSIS SUMMARY:

Status Post Left ACL Reconstruction, with Persistent Pain. According to the service treatment record and MEB narrative summary (NARSUM), the CI underwent surgery consisting of a left ACL reconstruction using a bone-patella-bone autograft and a partial medial meniscectomy in September 2006. Despite rehabilitation, his left knee continued to be symptomatic. He underwent a second left knee surgery with medial plica removal and debridement of small amounts of synovium on the anterior border of the medial meniscus in October 2007.

During the 3 March 2008 MEB examination (recorded on DD Forms 2807-1 and 2808), 8 months prior to separation, the CI indicated he had knee trouble. Physical examination showed a ligamentously stable left knee without evidence of a meniscal tear, and full strength with extension and flexion. However, there was tenderness along the medial and lateral joint lines. On 24 March 2008, the physical therapy (PT) examiner, 7 months prior to separation, noted complaints of left knee pain and increased edema with daily activities, especially running.     On

examination there was normal strength of the left lower extremity. Range of motion (ROM) testing showed 0-138 degrees of extension-to-flexion (normal 0-140).

The 27 March 2008 MEB NARSUM examination, 7 months prior to separation, noted complaints of persistent left knee pain with running. Physical examination showed a normal gait without quadriceps atrophy or effusion. The left knee was ligamentously stable and there was no evidence of meniscal pathology. X-rays showed evidence of prior reconstruction tunnels, but there were no loose bodies or osteochondral defects. At the 18 April 2008 PT clinic visit, the CI reported increased pain and edema with running and with extended periods of weight bearing. On examination he was noted to have normal left knee strength and full ROM.

At the 12 January 2009 VA Compensation and Pension (C&P) examination, 2 months after separation, the CI reported left knee pain, but denied giving way, instability, episodes of dislocation or subluxation, locking, effusion or inflammation. Physical examination showed left knee pain, but his gait was normal and there were no clicks, snaps, grinding or instability; and no patellar, meniscal, tendon or bursae abnormality. Left knee ROM testing showed extension-to- flexion of 0-140 degrees with pain but no limitation after repetition.

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 (arthritis, degenerative). The VA also rated the left knee condition 10%, coded 5259 (removal of symptomatic semilunar cartilage), based on the C&P examination, citing symptomatic removal of semilunar cartilage. There was evidence of painful motion with functional loss supporting a 10% rating based on
§§4.59, 4.40 and 4.45. The 5259 code (cartilage, semilunar, removal of, symptomatic) was also applicable in this case, but the maximum 10% rating under that code provides no additional benefit to the CI. The panel considered other VASRD knee and analogous codes, but all were less applicable and/or not advantageous for rating. There was therefore no higher rating than the 10% adjudicated by the PEB available under any applicable VASRD 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 left knee condition.

BOARD FINDINGS: In the matter of the 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:

2	PD-2017-03036

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 30 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 for 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.

Copy to: PDBR