RECORD OF PROCEEDINGS PHYSICAL DISABILITY BOARD OF REVIEW

NAME: XXXXXXXXXXXXXXX		CASE: PD-2021-00017 BRANCH OF SERVICE: MARINE CORPS	SEPARATION DATE: 20061115

SUMMARY OF CASE: Data extracted from the available evidence of record reflects this covered individual (CI) was a Reserve E4, Rifleman, medically separated for “left knee internal derangement” with a disability rating of 0%.

CI CONTENTION:	“Received higher VA ratings for conditions considered.”	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 - 20060913	VARD - 20070417	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Left Knee Internal Derangement	5260	0%	Left Knee DJD	5260	10%	20070126	
Left Foot Interdigital Neuroma	Cat II	Left Foot Stress Fracture	5284	0%	20070126	
Hypertension	Cat III	Hypertension	7101	10%	20070126	
Obstructive Sleep Apnea	Cat III	Sleep Apnea	6847	50%	20070126	
COMBINED RATING: 0%	COMBINED RATING OF ALL VA CONDITIONS: 70%	

ANALYSIS SUMMARY:

Left Knee Internal Derangement. According to the service treatment record (STR) and MEB narrative summary (NARSUM), the CI underwent left knee medial plica excision in January 2006.

At the 15 July 2006 MEB examination (recorded on DD Forms 2807-1 and 2808), 4 months prior to separation, he reported stiff and painful knees, and physical findings revealed lower extremity tenderness and left knee flexion limited to 95 degrees. During the 16 August 2006 MEB NARSUM examination, the CI complained of left knee pain that prevented high-impact loading, running, and prolonged standing, but denied locking or giving way. The orthopedic examination on 8 August 2006 found patellofemoral tenderness, chondromalacia patella, and difficulty with knee bends.

The 26 January 2007 VA Compensation and Pension (C&P) examination, 2 months after separation, noted complaints of left knee problems related to physical training. Physical examination showed range of motion from 0-140 degrees (normal) with no evidence of pain.

The panel directed attention to its rating recommendation based on the above evidence. The PEB rated the left knee condition 0%, coded 5260 (limitation of leg flexion), and also listed left foot interdigital neuroma as a related Category II condition, which the panel determined to be reasonably justified as separately unfitting for rating consideration. The VA rated the left knee condition 10%, coded 5260, based on the C&P examination, citing leg flexion limited to 45 degrees. Panel members agreed that a 10% rating for limitation of motion or painful motion was not justified since the examination most proximate to separation (VA C&P) documented full ROM without pain. While the panel other VASRD knee and analogous codes, all were less applicable and/or not advantageous for rating. There was therefore no higher rating than the 0% adjudicated by the PEB. 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.

Contended PEB Condition: Left Foot Interdigital Neuroma. The contended condition was determined to be related and contributed to the primary unfitting condition, and caused the CI to be placed in a limited duty status; it was also implicated in the non-medical assessment and was forwarded by the MEB as a possible unfitting condition. The MEB examination, documented continued tenderness, and the MEB NARSUM noted that he reported having left foot pain that altered his gait. During the VA C&P examination, the CI complained of foot pain precipitated by prolonged walking, and the examiner noted he was unable to stand for more than a few minutes or walk more than a mile. Therefore, panel members concluded that the preponderance of evidence indicated the left foot condition was justified as separately unfitting.

The panel next proceeded with its rating recommendation. The only finding during the MEB and C&P examinations was tenderness, but there was no limitation of motion or painful motion to support a 10% rating based on §4.59, §4.40 and §4.45 under code 5022 (periostitis). Panel members also agreed that a 0%, but no higher, not warranted under the 5284 code (foot injuries, other) for minimal impairment. There were no other applicable codes to consider. After due deliberation, considering all the evidence and mindful of VASRD §4.3 (reasonable doubt), the panel recommends a disability rating of 0% for the left foot condition, coded 5284.

Contended PEB Conditions: Hypertension and Obstructive Sleep Apnea. The panel’s main charge is to assess the fairness of the PEB determination that the contended conditions were not unfitting. Neither of the conditions wer implicated in the non-medical assessment, or noted as failing retention standards. There was no performance-based evidence from the record that either of the conditions significantly interfered with satisfactory duty performance at separation. After due deliberation, the panel concluded there was insufficient cause to recommend a change in the PEB fitness determination for either of the contended conditions, so no additional disability ratings are recommended.

BOARD FINDINGS: In the matter of the left knee condition and IAW VASRD §4.71a, the panel recommends no change in the PEB adjudication. In the matter of the contended left foot condition, the panel agrees it was unfitting and recommends a disability rating of 0%, coded 5284 IAW VASRD §4.72. In the matter of the contended hypertension and obstructive sleep apnea, the panel recommends no change from the PEB determination as not unfitting. There are no other conditions within the panel’s scope of review for consideration.

As the proposed new combined disability ratings result in no change to the combined disability rating previously assigned, the panel recommends no modification or re-characterization of the CI’s disability and separation determination.
CONDITION	VASRD CODE	PERMANENT RATING	
Left Knee Internal Derangement	5260	0%	
Left Foot Interdigital Neuroma	5284	0%	
	COMBINED	0%	

The following documentary evidence was considered:

Exhibit A. DD Form 294, dated 20210112, w/atchs Exhibit B. Service Treatment Record
Exhibit C. Department of Veterans Affairs Record

6/8/2021

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
6040
CORB:  001
7 March 2022

From: Director, Secretary of the Navy Council of Review Boards To:	XXXXXXXXXXXXXXX

Subj:	Physical Disability Board of Review Determination Ref:	(a) 6040.44(Series)
1.	The Physical Disability Board of Review (PBDR) reviewed your case in accordance with reference
(a) and forwarded their recommendation for action.

2.	

On 3 March 2022, the Assistant Secretary of the Navy (Manpower and Reserve Affairs) accepted the of no change to your characterization of separation or disability rating
assigned.

3.	The PDBR determination is final and not subject to appeal or review.