RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  xx	BRANCH OF SERVICE:  MARINE CORPS
CASE NUMBER:  PD1200629	SEPARATION DATE:  20020831
BOARD DATE:  20130821

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty LCpl/E-3 (0151/Administrative Clerk), medically separated for left knee posterior cruciate ligament (PCL) tear.  The CI was a passenger in a motor vehicle accident (MVA) in November 2000.  He was wearing his seat belt and sustained an injury to the left knee.  The CI was treated with rehabilitation and arthroscopic surgery.  The left knee PCL tear condition could not be adequately rehabilitated to meet the physical requirements of his Military Occupational Specialty or satisfy physical fitness standards.  He was placed on limited duty and referred for a Medical Evaluation Board (MEB).  The MEB forwarded left knee PCL tear, surgically treated; left knee chondromalacia of the medial femoral condyle, surgically and medically treated; and left knee effusion, medically and surgically treated for Physical Evaluation Board (PEB) adjudication.  The PEB adjudicated the left knee PCL tear condition as unfitting, rated 10%, with application of the Veterans Affairs Schedule for Rating Disabilities (VASRD).  The CI made no appeals and was medically separated.

CI CONTENTION:  “I feel the injury was more severe then explained to me.  Throughout the years I have always had a stiffness & swelling of my knee.  The scar has bothered me also with excessive itching.  I now have trouble standing for short periods of time at work & I general.  I cannot engage in physical activities for a long period of time.  I constantly have knee swelling & stiffness.  I go to the VA & complain about my knee locking up & on several occasions I have fallen.  My knee is not the same & worsens every year.  I have received knee braces & a walking cane from the VA.  Now I am starting to have right knee pains & stiffness.  My lower back is also another problem I am starting to encounter.  I hope to start physical therapy on June 15 2012.”

SCOPE OF REVIEW:  The Board wishes to clarify that the scope of its review as defined in DoDI 6040.44, Enclosure 3, paragraph 5.e.(2) is limited to those conditions which were determined by the PEB to be specifically unfitting for continued military service; or, when requested by the CI, those condition(s) “identified but not determined to be unfitting by the PEB.”  The ratings for unfitting conditions will be reviewed in all cases.  The other requested condition, lower back, is not within the Board’s purview.  Any conditions or contention not requested in this application, or otherwise outside the Board’s defined scope of review, remain eligible for future consideration by the Board for Correction of Naval Records.

RATING COMPARISON:

Service IPEB – Dated 20020627	VA (~6 Mos. Pre-Sep and ~8 Mos Post-Sep)
All Effective Date 20020901	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Left Knee Posterior Cruciate Ligament Tear	5257	10%	Residuals, Posterior Cruciate Ligament Tear, Left Knee s/p Repair	5257	10%	20020225
20030418	
↓No Additional MEB/PEB Entries↓	0% X 1 / Not Service-Connected x 7		
Combined:  10%	Combined:  10%	

ANALYSIS SUMMARY:  The Disability Evaluation System (DES) is responsible for maintaining a fit and vital fighting force.  While the DES considers all of the member's medical conditions, compensation can only be offered for those medical conditions that cut short a member’s career, and then only to the degree of severity present at the time of final disposition.  The DES has neither the role nor the authority to compensate members for anticipated future severity or potential complications of conditions resulting in medical separation nor for conditions determined to be service-connected by the Department of Veterans Affairs (DVA) but not determined to be unfitting by the PEB.  The DVA, operating under a different set of laws (Title 38, United States Code), is empowered to compensate all service-connected conditions and to periodically re-evaluate said conditions for the purpose of adjusting the veteran’s disability rating should the degree of impairment vary over time.  The Board’s role is confined to the review of medical records and all evidence at hand to assess the fairness of PEB rating determinations, compared to VASRD standards, based on severity at the time of separation.

Left Knee Posterior Cruciate Ligament Tear Condition.  There were three goniometric range-of-motion (ROM) evaluations in evidence, with documentation of additional ratable criteria, which the Board weighed in arriving at its rating recommendation; as summarized in the chart below.

Left Knee ROM
(Degrees)	VA C&P 
~6 Mos. Pre-Sep
(20020225)	MEB 
~5 Mos. Pre-Sep
(20020325)	VA C&P 
~8 Mos. Post-Sep
(20030418)	
Flexion (140 Normal)	140/110	 145	140	
Extension (0 Normal)	0	-5	0	
Comment	Limping gait
No instability
Painful motion	Symmetric ROM
Normal gait
2mm posterior sag (equal to right)
Mild laxity = both knees
Pseudo Lachman	Symmetric ROM
Pain did not limit full ROM 
Gait normal
Mild laxity; not compared to right	
§4.71a Rating	10%	10%	10%	

The MEB narrative summary (NARSUM) notes the CI’s left knee was injured in a MVA in November 2000 resulting in a PCL tear.  Preoperatively the left knee posterior translation was 12 millimeters compared to 3 millimeters in the healthy uninjured right knee (18 May 2001 orthopedic exam).  He underwent left knee arthroscopy with PCL reconstruction with patellar tendon graft on 6 July 2001.  During arthroscopic examination, the knee was noted to have chondromalacia of the medial joint compartment; otherwise the remainder of the knee was normal.  At the VA Compensation and Pension (C&P) examination on 25 February 2002, performed prior to the MEB orthopedic examination, the CI reported left knee pain, weakness, stiffness and swelling.  On examination there was a left leg limp with gait.  There was no swelling of the extremities.  Left knee ROM had pain beginning at 90 degrees and restricted ROM without pain at 110 degrees.  Knee restriction was reported as caused by soft tissue and bony restriction.  There was pain with forced extension.  There was no ligamentous instability and meniscus tests were negative.  At the time of the MEB NARSUM orthopedic examination on  25 March 2002, the CI reported left anteromedial knee pain with 10 minutes of walking and with ascending stairs.  He noted occasional swelling and occasional giving way with stairs.  There was no catching or locking and muscle strength was noted to have greatly improved since surgery.  The CI was unable to run and perform his activities as a marine due to his knee giving way; swelling and anteromedial left knee pain.  The MEB physical exam noted a normal gait.  There was quadricep muscle atrophy and mild effusion of the left knee.  There was no joint line tenderness.  The ROM was the same on both knees (hyperextension to -5 degrees and flexion to 145 degrees).  There was some mild laxity of both anterior and PCLs of both affected and non-affected knees.  The left knee showed 2 millimeters of posterior sag (translation), essentially the same as recorded for the normal right knee in the previous examination cited above.  X-rays from October 2001 were noted to show good position of the hardware.  At the C&P examination on 18 April 2003, 8 months after separation, the CI reported left knee pain, weakness, stiffness and swelling.  He wore a brace when walking long distances or when climbing ladders.  On examination the gait was normal.  He was able to walk on his toes but not on his heels.  ROM was normal and equal in both knees (flexion 140 degrees, extension 0 degrees).  There was some crepitus of the left knee and laxity of the anterior cruciate ligament and PCLs.  Meniscus tests were negative.  X-rays showed chronic postsurgical change.

The Board directs attention to its rating recommendation based on the above evidence.  The PEB rated the left knee condition 10%, coded 5257.  The VA also rated the left knee condition 10%, coded 5257, based on the C&P examinations from February 2002 prior to separation and April 2003 after separation.  There was no limitation of motion that supported a minimum rating under VASRD codes for limitation of flexion (5260) or extension (5261).  There was no meniscus pathology to warrant consideration under codes for dislocated meniscus (5258) or postoperative meniscus removal (5259).  Both the PEB and VA adjudicated a 10% rating using the 5257 code for other knee impairment, recurrent subluxation or lateral instability.  The CI did have an injury of the PCL causing instability.  Following surgery, the residual laxity of the PCL approximated the healthy right knee.  All members agreed the residual laxity did not approach a moderate level and did not exceed the slight level.  Orthopedic examiners recorded a similar degree of ligamentous laxity in both knees indicating a normal finding for the CI.  The Board concluded the minimal laxity with functional limitation supported the 10% rating adjudicated by the PEB and VA but that dual rating was not supported by the evidence of the record prior to separation.  All Board members agreed there was no route to a higher rating.  After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the Board concluded that there was insufficient cause to recommend a change in the PEB adjudication for the left knee condition.

BOARD FINDINGS:  IAW DoDI 6040.44, provisions of DoD or Military Department regulations or guidelines relied upon by the PEB will not be considered by the Board to the extent they were inconsistent with the VASRD in effect at the time of the adjudication.  In the matter of the left knee condition and IAW VASRD §4.71a, the Board unanimously recommends no change in the PEB adjudication.  There were no other conditions within the Board’s scope of review for consideration.

RECOMMENDATION:  The Board, therefore, recommends that there be no recharacterization of the CI’s disability and separation determination, as follows:

UNFITTING CONDITION	VASRD CODE	RATING	
Left Knee Posterior Cruciate Ligament Tear	5257	10%	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20120608, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans’ Affairs Treatment Record

xx
President
Physical Disability Board of Review

MEMORANDUM FOR DIRECTOR, SECRETARY OF THE NAVY COUNCIL OF REVIEW 
                                        BOARDS 

Subj:  PHYSICAL DISABILITY BOARD OF REVIEW (PDBR) RECOMMENDATIONS
 
Ref:   (a) DoDI 6040.44
          (b) CORB ltr dtd 13 Dec 13

      In accordance with reference (a), I have reviewed the cases forwarded by reference (b), and, for the reasons provided in their respective forwarding memorandums, approve the recommendations of the PDBR that the following individual’s records not be corrected to reflect a change in either characterization of separation or in the disability rating previously assigned by the Department of the Navy’s Physical Evaluation Board:

- former USMC
- former USN
- former USN

						      xx
	     					       Assistant General Counsel
						         (Manpower & Reserve Affairs)