RECORD OF PROCEEDINGS
                     PHYSICAL DISABILITY BOARD OF REVIEW

NAME: XXXX             BRANCH OF SERVICE: marine corps
CASE NUMBER:  PD0900714                 SEPARATION DATE: 20080715
BOARD DATE: 20110217


SUMMARY OF CASE:  Data extracted  from  the  available  evidence  of  record
reflects that this  covered  individual  (CI)  was  a  USMC  PFC/E-2  (9900,
Recruit) medically separated in July 2008 after six months of service.   The
medical basis for separation was right knee pain.  His  knee  problem  began
in January 2008 during the  first  few  weeks  of  basic  training  when  he
suffered a buckling injury to his right knee  while  doing  walking  lunges.
He presented with lateral knee pain in his right knee.  X-rays of the  right
knee were negative.  Magnetic Resonance Imaging  (MRI)  of  the  right  knee
(February 2008) revealed a contusion of  the  medial  femoral  condyle.   In
spite of treatment, his right knee pain failed to improve  sufficiently  for
him to continue his training.  The CI underwent a Medical  Evaluation  Board
(MEB).  His right knee condition was forwarded to  the  Physical  Evaluation
Board (PEB) as medically unacceptable.  The PEB adjudicated the  right  knee
condition as unfitting, rated  10%  IAW  with  the  Veterans  Administration
Schedule for Rating Disabilities (VASRD).  The CI accepted the PEB  findings
and was medically separated.


CI CONTENTION:  The CI states, “Didn’t include left knee injury  and  injury
was more severe than they document.  It’s been a year and ten  months  since
injury and still have a hard time walking. The right knee pain is still  the
same as the day I injured it.  Currently taking  morphine  and  only  slight
decrease in the sharpness of pain, injury happened during  recruit  training
and medical treated me as it was Marine it up and didn’t try  or  listen  to
me about what was going on.”


RATING COMPARISON:

|Navy PEB (dated 20080616)      |VA (6 mo. Post-Separation) – Effective  |
|                               |20080715                                |
|Condition                      |Code                                    |


  * Effective 20090202


ANALYSIS SUMMARY:

Right Knee Condition.  As noted above, the right knee problem  began  during
basic training.  Many treatment modalities were  tried  including,  physical
therapy  (PT),   transcutaneous   electrical   nerve   stimulation   (TENS),
orthopedic  brace,  non-steroidal  anti-inflammatory  drugs   (NSAIDs)   and
steroid  injections.   It  was  recommended  that  he   undergo   diagnostic
arthroscopy.   However,  he  refused  to  have  arthroscopic  surgery.   Two
examinations and range of motion (ROM) evaluations of the  right  knee  were
in  evidence,  which  the  Board  weighed  in   arriving   at   its   rating
recommendation.  The MEB  right  knee  examination  was  three  months  pre-
separation.  At that exam, there was no deformity,  edema,  erythema,  color
changes, ecchymosis or effusion.  His  neurovascular  exam,  ligaments,  and
extensor  mechanism  were  all  intact.   Patellar  apprehension  test   was
negative, but the patellar compression test  was  positive.   There  was  no
tenderness to palpation (TTP) at the  medial  and  lateral  joint  line  and
McMurray's was negative.  There was no opening with varus stress  at  0  and
30 degrees, and negative Tinels at the fibular  head.   Right  knee  flexion
was 135⁰ (140⁰ is normal) and extension was 0⁰ (normal).   The  ROM  results
are summarized in the table below.

|Right Knee           |Separation Date: 20080715    |
|Goniometric ROM      |MEB – 20080318|VA C&P -      |
|                     |              |20090114      |
|Flexion  (140⁰ is    |135⁰          |130⁰          |
|normal)              |              |              |
|Extension  (0⁰ is    |0⁰            |0⁰            |
|normal)              |              |              |
|§4.71a Rating        |10%           |10%           |
|Comments             |10% rating    |10% rating    |
|                     |based on      |based on      |
|                     |painful motion|painful motion|

The VA Compensation & Pension (C&P) examination of the right knee was on  14
January 2009 (six months post-separation).   At  that  exam,  there  was  no
edema, crepitus, or instability.  Drawer  sign  was  negative.   Right  knee
flexion was 130⁰ (140⁰ is normal) and extension was 0⁰ (normal).   Based  on
that examination, the VA assigned a  10%  disability  rating  to  the  right
knee.

The Board evaluated all evidentiary information  available.   It  was  noted
that the Navy PEB and the VA chose different coding options  for  the  right
knee, but both assigned a 10% disability rating. At the time  of  separation
from service, the CI was clearly experiencing persistent  right  knee  pain,
with some limitation of motion.  There was no documented objective  evidence
of ligamentous laxity or joint instability.   The  ROM  limitation  did  not
meet VASRD criteria for a disability percentage (based  upon  knee  and  leg
codes, 5260 through  5261).   However,  IAW  VASRD  §4.59  and  §4.71,  when
limitation of motion of a specific involved major  joint  is  noncompensable
under the appropriate diagnostic code, a rating of  10%  is  appropriate  if
there is satisfactory evidence of painful motion.   After  due  deliberation
and careful consideration of all available evidence, the  Board  unanimously
recommends a separation rating of 10% for right knee pain.

Left Knee Condition.  CI complained of  some  left  knee  pain  in  February
2008.  At that time, the left knee was examined, x-rayed, and  no  pathology
was found.  On the DD Form 2807-1 (dated 9  April  2008),  CI  listed  right
knee pain, but made no mention of left knee.  On the DD  Form  2808  (Report
of Medical Examination) dated 10 April 2008, there is  no  evidence  of  any
abnormality involving the left knee.  During the  C&P  exam  on  14  January
2009 (six months post-separation) the CI’s left knee was normal.  There  was
no edema, no tenderness to palpation (TTP),  no  crepitus,  no  instability,
and a negative Drawer test.  He fully extended to 0⁰ with no  pain,  and  he
fully flexed to 140⁰ with no pain.  The Board unanimously  agrees  that  the
left knee was not unfitting at the time of separation from  service  and  is
not relevant for disability rating.

History of Other Conditions  (documented  in  Disability  Evaluation  System
(DES) package).  Several additional conditions were identified  in  the  DES
file.  None of these other conditions were  under  active  treatment  during
the MEB period and  none  were  implicated  in  the  Commander’s  statement.
These other conditions were all reviewed by  the  Action  Officer  and  were
considered by the Board.  There is no clearly documented evidence  that  any
of these conditions caused a significant adverse effect on  the  performance
of required military duties.  These other conditions are all judged  by  the
Board to be not unfitting at the time of separation from  service,  and  are
not  relevant  for  disability  rating.   The  Board,  therefore,   has   no
reasonable basis for recommending any additional  unfitting  conditions  for
separation rating.

History of Other Conditions (not documented in DES package).  Mood  disorder
was also noted by the Board.  There is no clearly documented  evidence  that
this condition was a matter of record in the DES package.   Therefore,  mood
disorder is judged to be outside the scope of this Board.


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.  The Board did not surmise from the record  in
this case that any prerogatives outside the VASRD were exercised.

In the matter of the right knee condition and IAW VASRD  §4.71a,  the  Board
unanimously recommends no change in the PEB adjudication.

In the matter of the left knee condition 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.


Mood disorder (rated by the VA) was not  a  matter  of  record  in  the  DES
package and is, therefore, outside the scope of the Board.


RECOMMENDATION: The Board,  therefore,  recommends  that  there  be  no  re-
characterization of the CI’s disability and separation determination.

|UNFITTING CONDITION                               |VASRD CODE  |RATING  |
|Right Knee Pain                                   |5099-5003   |10%     |
|COMBINED    |10%     |




The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20091201, w/atchs.
Exhibit B.  Service Treatment Record.
Exhibit C.  Department of Veterans' Affairs Treatment Record.




                                        Deputy Director
                                                                    Physical
Disability Board of Review


MEMORANDUM  FOR  DIRECTOR,  SECRETARY  OF  THE  NAVY   COUNCIL   OF   REVIEW

                                         BOARDS

Subj:  PHYSICAL DISABILITY BOARD OF REVIEW (PDBR) RECOMMENDATION ICO
          XXXX, FORMER USMC, XXX XX XXXX

Ref:   (a) DoDI 6040.44
             (b) PDBR ltr dtd 8 Mar 11

      I have reviewed the subject case pursuant to reference  (a)  and,  for
the reasons set forth in reference (b), approve the  recommendation  of  the
Physical Disability Board of Review Mr. XXX’s records not  be  corrected  to
reflect a change in either his characterization  of  separation  or  in  the
disability rating previously  assigned  by  the  Department  of  the  Navy’s
Physical Evaluation Board.



                                        Principal Deputy
                                        Assistant Secretary of the Navy
                                          (Manpower & Reserve Affairs)