RECORD OF PROCEEDINGS PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXXXXXXXXXXX		CASE: PD-2017-04743 BRANCH OF SERVICE: MARINE CORPS	SEPARATION DATE: 20080615

SUMMARY OF CASE: Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E3, Infantry Riflemen, medically separated for “left anterior cruciate [ACL] ligament tear, status post [S/P] reconstruction” with a disability rating of 10%.

CI CONTENTION: Review of all conditions requested. 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 - 20080409	VARD - 20090723	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Left ACL Tear S/P Reconstruction	5299-5003	10%	Left Knee MCL, ACL Tears S/P Surgical Repair w/ Instability	5257	10%	20090407	
Left MCL Tear, S/P
Reconstruction	Cat II	Left Knee MCL and ACL Tears S/P Surgical
Repair with Limitation of Motion	5299-
5260	10%	20090407	
COMBINED RATING: 10%	COMBINED RATING OF ALL VA CONDITIONS: 20%	

ANALYSIS SUMMARY:

Left ACL Tear S/P Reconstruction. According to the service treatment record (STR) and MEB narrative summary (NARSUM), the CI’s left knee condition began in September 2007 when he sustained a twisting injury to his left knee and felt an immediate pop after jumping off the side of a 7-ton truck for the fourth time. In November 2007, he subsequently underwent left ACL and medial collateral ligament (MCL) reconstructions using a tibial allograft for the ACL and an Achilles allograft for the MCL. One week postoperatively he had a moderate effusion and soft tissue swelling from the knee to the ankle. The operative site was healing well and the knee lacked 15 degrees of extension; flexion was to 100 degrees (normal 140); and the knee was stable The MEB NARSUM examination noted complaints of pain in his left knee when attempting to run. He was able to ambulate without difficulty; however, after running a couple of feet, he felt unsure about his left knee. Physical examination showed no effusion, full ROM, and normal strength. His knee was stable to varus and valgus stressing, and he had no instability based on negative

anterior drawer, pivot shift, and Lachman’s tests. X-rays showed well placed tunnels and retained hardware.

At the 7 April 2009 VA Compensation and Pension (C&P) examination, 10 months after separation, the CI reported pain and stiffness in his left knee. The knee felt weak, but did not give out; however, it felt stiff and hurt after walking a quarter mile to one mile. Physical examination showed a normal gait, mild tenderness, and mild anterior instability. The left knee ROM following repetitive movement was flexion of 100 degrees and there was normal extension of 0 degrees with pain. There was no additional loss of motion due to pain, fatigue, weakness, or lack of endurance following 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 (degenerative arthritis). The panel agreed that the Category II left MCL tear, s/p reconstruction condition contributed to or was related to the primary unfitting condition, but was not separately ratable, and was an intertwined diagnosis therefore the overall knee impairment from that diagnosis was subsumed under the PEB rating for the knee since more than one rating based on the same impairment is prohibited IAW VASRD §4.14 (avoidance of pyramiding). The VA rated the left knee condition 10%, analogously coded 5299-5260 (leg, limitation of flexion), and also rated an additional 10% coded 5257 (knee, other impairment: recurrent subluxation or lateral instability) based on the C&P examination, citing painful or limited motion of a major joint, and recurrent subluxation or lateral instability of the knee which was slight. 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 panel considered other VASRD knee and analogous codes, but all were less applicable and not advantageous for rating. There was therefore no VASRD
§4.71a rating higher than the 10% adjudicated by the PEB 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 left knee condition.

BOARD FINDINGS: In the matter of the left anterior cruciate ligament tear, status post reconstruction 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-2017-04743

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
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
1.	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 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.