RECORD OF PROCEEDINGS

PHYSICAL DISABILITY BOARD OF REVIEW

NAME: XXXXXXX BRANCH OF SERVICE: marine corps

CASE NUMBER: PD200900578 SEPARATION DATE: 20070930

BOARD DATE: 20110519

SUMMARY OF CASE: Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty Cpl (3521, Motor Transport Mechanic) medically separated for left medial knee pain. He did not respond adequately to treatment and was unable to perform within his military occupational specialty or meet physical fitness standards. He was placed on limited duty (LIMDU), and underwent a Medical Evaluation Board (MEB). Left knee pain and pain disorder related to psychological factors were forwarded to the Physical Evaluation Board (PEB) as medically unacceptable IAW SECNAVINST 1850.4E. The PEB adjudicated the “medial knee pain which prevents him from running” condition as unfitting, rated 0% with application of SECNAVINST 1850.4E and probable application of DoDI 1332.39 and the Veterans Administration Schedule for Rating Disabilities (VASRD). The CI made no appeals and was medically separated with a 0% disability rating.

CI CONTENTION: “Left knee damage incurred active duty service.”

RATING COMPARISON:

* The CI did not have a C&P exam. These were scheduled on 20080207 and 20091215, but the CI did not appear.

ANALYSIS SUMMARY:

Medial Knee Pain. The CI first noted left knee pain without trauma in February 2006 while running. X-rays and magnetic resonance imaging (MRI) of the knee were unremarkable. Steroid injections, physical therapy (PT), and a six-month LIMDU period failed to resolve the symptoms. Diagnostic arthroscopy on 28 September 2006 revealed a medial plica which was excised back to the capsular margin. The menisci, ligaments, and chondral surfaces were noted to be normal. PT was resumed, but he was not able to return to running without knee pain. After a second six-month LIMDU, a MRI revealed lateral femoral condyle edema which did not correlate with the symptoms. Corticosteroid injections were again unsuccessful. The MEB exam on 25 April 2007 four months prior to separation demonstrated range of motion (ROM) of the left knee from 0 to 120 degrees of flexion, with tenderness to palpation over the well healed medial incision. There was no effusion. He had two well-healed anterior portal incisions. There was no pain with ROM. However, there was pain at extremes of flexion. He had a negative Lachman, and a negative anterior drawer and posterior drawer. His knee was stable to varus and valgus stress, at 0 and 30 degrees. His extremity was neurovascularly intact. The examiner stated that the etiology of the pain was unknown. It was noted on the DD Form 2807 that he used a knee brace. The PEB coded the knee condition as 5299-5003 (analogous to degenerative arthritis), rated 0%. The second MRI did reveal left lateral condylar edema, but since two joints were not involved, the minimal compensable rating of 10% was not applicable under the arthritis code. The limitation of motion of the knee was also insufficient under any code to grant a compensable rating. However, under 5003, non-compensable limitation of flexion secondary to objective findings such as swelling, muscle spasm, or satisfactory evidence of painful motion does grant a rating of 10%. The Board determined that the history of medial plica repair and lateral condylar edema on MRI were objective findings. The VA used the code 5299-5259 (analogous to surgical removal of the meniscus) for medical plica syndrome, status post arthroscopy of the left knee, rated 10%. The Board also considered a code of 5020 for synovitis. However, neither 5299-5259 nor 5020 would increase the disability rating above 0%. After due deliberation, considering the totality of the evidence and mindful of VASRD §4.3 (reasonable doubt), the Board unanimously recommends a permanent disability rating of 10% in this case, coded 5299-5003.

Remaining Conditions. Other conditions identified in the Disability Evaluation System file were Wolff-Parkinson-White (WPW) syndrome, neck mass biopsy, hay fever, hearing loss, heartburn, and insomnia. Several additional non-acute conditions or medical complaints were also documented. None of these conditions were clinically active during the MEB period, none were the basis for limited duty, and none were implicated in the commander’s statement. These conditions were reviewed by the action officer and considered by the Board. It was determined that none could be argued as unfitting and subject to separation rating. No other conditions were service connected with a compensable rating by the VA within twelve months of separation or contended by the CI. The Board therefore has no reasonable basis for recommending any additional unfitting conditions for separation rating.

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 that they were inconsistent with the VASRD in effect at the time of the adjudication. In the matter of the left knee condition, the Board unanimously recommends a rating of 10% coded 5299-5003 IAW VASRD §4.71a and §4.3. In the matter of the WPW syndrome, neck mass biopsy, hay fever, hearing loss, heartburn and insomnia conditions or any other medical conditions eligible for Board consideration, the Board unanimously agrees that it cannot recommend any findings of unfit for additional rating at separation.

RECOMMENDATION: The Board unanimously recommends that the CI’s prior determination be modified as follows, effective as of the date of his prior medical separation:

______________________________________________________________________________

The following documentary evidence was considered:

Exhibit A. DD Form 294, dated 20000918, w/atchs.

Exhibit B. Service Treatment Record.

Exhibit C. Department of Veterans' Affairs Treatment Record.

Deputy Director

Physical Disability Board of Review

MEMORANDUM FOR DEPUTY COMMANDANT, MANPOWER & RESERVE AFFAIRS

Subj: PHYSICAL DISABILITY BOARD OF REVIEW (PDBR) RECOMMENDATION

ICO XXXXX, FORMER USMC, XXX XX XXXX

Ref: (a) DoDI 6040.44

(b) PDBR ltr dtd 26 May 11

1. I have reviewed the subject case pursuant to reference (a) and approve the recommendation of the Physical Disability Board of Review (reference (b)).

2. The subject member’s official records are to be corrected to reflect the following disposition:

a. Separation from the Naval service due to physical disability rated at 10 percent (increased from 0 percent) effective 30 September 2007.

3. Please ensure all necessary actions are taken to implement this decision including notification to the subject member once those actions are completed.

Assistant General Counsel

(Manpower & Reserve Affairs)