RECORD OF PROCEEDINGS PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXXXXXXX		CASE: PD-2017-05691 BRANCH OF SERVICE: MARINE CORPS	SEPARATION DATE: 20070415

SUMMARY OF CASE: Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E6, Field Artillery Operations Man, medically separated for “chronic bilateral knee pain,” rated 10% for each knee, with a combined disability rating of 20%.

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 – 20070119	VARD - 20071015	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Bilateral Knee Pain	5009-5003	10%	Degenerative Joint Disease, Right Knee	5010-5020	10%	20070628	
	5009-5003	10%	
Degenerative Joint Disease, Left Knee	

5010-5020	

10%	

20070628	
Right Medial Femoral Condyle Grade II to III Chondromalacia	Cat II					
Bilateral Grade III to IV Trochlear Chondromalacia	Cat II					
COMBINED RATING: 20%	COMBINED RATING OF ALL VA CONDITIONS: 40%	

ANALYSIS SUMMARY:

Chronic Bilateral Knee Pain. According to the service treatment record and MEB narrative summary (NARSUM), the CI underwent arthroscopic surgery on 16 March 2006 to repair a left knee medial and lateral meniscus tear, and a right knee lateral meniscus tear. A chondroplasty was also performed on each knee after the surgeon found right medial femoral condyle grade II- III and bilateral trochlear grade III-IV chondromalacia. The CI deployed in October 2006 and experienced recurring bilateral knee pain after performing high impact activities. Despite pain medication and steroid/anesthetic injections to the knee joint spaces, chronic pain persisted.

The 14 December 2006 MEB NARSUM examination, 4 months prior to separation, noted complaints of bilateral knee pain with no relief from nonsteroidal anti-inflammatory drugs. The

examiner found mild effusion and pain during patellofemoral grinding in both knees, but no tenderness over the medial or lateral joint lines, instability, laxity or evidence of meniscal tears. Both knees had “full, active range of motion [ROM].” During the 18 December 2006 MEB examination (recorded on DD Forms 2807-1 and 2808), 4 days later, mild effusions of the left and right knees were noted with slightly decreased ROMs.

At the 28 June 2007 VA Compensation and Pension (C&P) examination, 2 months after separation, the CI reported constant bilateral knee pain, rated at 9/10, with weakness, stiffness, swelling, and lack of endurance. Physical examination showed an antalgic, stiff-legged, wide- based gait, but no knee joint deformity, swelling, laxity. Active right knee ROM was from 0-130 (normal 0-140), and active left knee ROM from 0-90 degrees. The examiner noted obvious discomfort with motion, but after repetition, there was there was no loss of motion secondary to pain, weakness, or lack of endurance. Strength was normal.

The panel directed attention to its rating recommendation based on the above evidence. The PEB rated the right and left knee conditions 10% each, both analogously coded 5099-5003 (arthritis, degenerative). The PEB listed right medial femoral condyle chondromalacia and bilateral trochlear chondromalacia as Category II conditions (contribute to or are related to the primary diagnoses), but panel members agreed that these diagnoses were intrinsic to the rated conditions and separate ratings could not be supported without pyramiding (VASRD §4.14); thus, they were appropriately subsumed under the same rating. The VA also rated each knee 10%, but analogously coded 5010-5020 (arthritis due to trauma-synovitis), based on the C&P examination, citing limitation of ROM, pain on motion, and crepitus of each knee. The panel noted that while there was no compensable limitation of flexion or extension (5260 or 5261) for either knee, the persistence of pain after meniscal surgery warranted a 10% rating under code 5259 (cartilage, semilunar, removal of symptomatic) for each knee. The panel considered other VASRD knee and analogous codes, but all were less applicable and/or not advantageous for rating. 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 and left knee conditions.

BOARD FINDINGS: In the matter of the chronic bilateral 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-2017-05691

DEPARrnENT OF THE NAVY
SECRETARY OF TI!E 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 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.