RECORD OF PROCEEDINGS 

PHYSICAL DISABILITY BOARD OF REVIEW 

 
 

  MARINE  CORPS 

BRANCH  OF  SERVICE: 
SEPARATION DATE:  20050615 

 
NAME:  XX 
CASE NUMBER:  PD1100913 
BOARD DATE:  20130206 
______________________________________________________________________________ 
 
SUMMARY  OF  CASE:    Data  extracted  from  the  available  evidence  of  record  reflects  that  this 
covered individual (CI) was an active duty Sgt/E-5 (3531/Motor Transport Operator), medically 
separated for bilateral knee pain, right greater than left.  The CI injured his right knee in 2002 
and had arthroscopy in December 2003 when a lateral meniscal tear and multiple loose bodies 
were noted.  Although the tear was debrided and the loose bodies were removed, the CI noted 
increased right knee pain.  A second arthroscopy in July 2004 noted the lateral meniscal tear 
had  propagated  and  it  was  again  debrided.    The  right  knee  also  had  a  full  thickness  lateral 
femoral condyle defect and this was treated with microfracture.  Left knee pain began in the 
spring of 2004.  The CI did not respond adequately to treatment and was unable to perform 
within his  Military  Occupational  Specialty  (MOS)  or  meet physical fitness  standards.    He  was 
placed on limited duty (LIMDU) and he underwent a Medical Evaluation Board (MEB).  Pain in 
joint, lower leg was forwarded to the Physical Evaluation Board (PEB) as medically unacceptable 
IAW SECNAVINST 1850.4E.  No other conditions appeared on the MEB’s submission.  The PEB 
adjudicated  the bilateral  knee  pain  condition as  unfitting,  rated  10%,  with  application  of the 
SECNAVINST 1850.4E.  The CI  made no appeals, and he was medically separated with a 10% 
combined disability rating. 
 
 
CI CONTENTION:  “I believe my condition was under rated (20%) based on my current medical 
conditions.  I strongly believe some things may have been overlooked or the proper medical 
test or exams were not conducted to confirm the severity of my injury/medical conditions.  At 
the point of my discharge (6.15.2011) I was not able to perform my regular job duties (MOS 
3531 Motor Transportation) due to my medical conditions, based on that I was not able to sit 
for long periods of time due to my knees locking up and the stability of my knees.  Unable to 
drive for long periods of time which my MOS required on a constant basis.” 
 
 
RATING COMPARISON: 
 
Service IPEB – Dated 20050321 
Condition 

Rating 

Code 

Bilateral Knee Pain, Right 
Greater Than Left 

5299-5003 

10% 

VA (1 Month Pre-Separation) – All Effective Date 20050616 
Condition 
Left Knee Osteoarthritis 
S/P  Right  Knee  Arthroscopic 
Surgery with Scar 
0% x 2/Not Service Connected x 1 
Combined:  20%* 

Rating 
10% 
10% 

Code 
5260* 
5260* 

Exam 
20050520 
20050520 
20050520 

↓No Additional MEB/PEB Entries↓ 
Combined:  10% 
*Left (20%) and Right (30%) knee instability 5257 and Left knee (10%) and Right knee (10%) painful scar 7804 added effective 
20110317 with combined increased to 70%. 
______________________________________________________________________________ 
 
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 rating for 
unfitting conditions will be reviewed in all cases.  The condition bilateral knee pain as requested 

for  consideration  meets  the  criteria  prescribed  in  DoDI  6040.44  for  Board  purview;  and,  is 
addressed below, in addition to a review of the ratings for the unfitting conditions.  The other 
requested  or  implied  conditions  are  not  within  the  Board’s  purview.    Any  condition  or 
contention not requested in this application, or otherwise outside the Board’s defined scope of 
review, remains eligible for future consideration by the Board for Correction of Naval Records.   
______________________________________________________________________________ 
 
ANALYSIS SUMMARY:  The Board’s authority as defined in DoDI 6040.44, resides in evaluating 
the fairness of the Disability Evaluation System fitness determinations and rating decisions for 
disability at the time of separation.  The Board utilizes VA evidence proximal to separation in 
arriving  at  its  recommendations;  and,  DoDI  6040.44  defines  a  12-month  interval  for  special 
consideration to post-separation evidence.  Post-separation evidence is probative only to the 
extent  that  it  reasonably  reflects  the  disability  and  fitness  implications  at  the  time  of 
separation. 
 
The  PEB  rated  right  knee  pain  and  left  knee  pain  together  under  the  single  analogous  5003 
(degenerative arthritis) code.  However, IAW DoDI 6040.44 the Board must apply only VASRD 
guidance to its recommendation.  The Board must therefore apply separate codes and ratings 
in its recommendations if compensable ratings for each joint are achieved IAW VASRD §4.71a.  
If the Board judges that two or more separate ratings are warranted in such cases, however, it 
must  satisfy  the  requirement  that  each  “unbundled”  condition  was  unfitting  in  and  of  itself 
using  a  reasonably  justified  standard.    The  Board  first  considered  whether  right  knee  pain, 
having  been  de-coupled  from  the  combined  PEB  adjudication,  remained  independently 
unfitting  as  established  above.    All  members  agreed  that  with  application  of  the  reasonably 
justified  standard,  right  knee  pain,  as  an  isolated  condition,  would  have  rendered  the  CI 
incapable of continued service within his MOS, and accordingly this condition merits a separate 
rating.  Recommendation for rating is discussed below.   
 
The  Board  next  considered  whether  left  knee  pain  remained  separately  unfitting,  having  de-
coupled  it  from  a  combined  PEB  adjudication.    In  analyzing  the  intrinsic  impairment  for 
appropriately  coding  and  rating  the  left  knee  pain  condition,  the  Board  is  left  with  a 
questionable  basis  for  arguing  that  left  knee  pain  was  indeed  independently  unfitting.    The 
LIMDU  medical  board  from  July  2004  (nearly  10  months  prior  to  separation)  listed  the  right 
knee only.  The medical board report prepared for the PEB mentioned no specific injury of the 
left knee stated the right knee pain was worse than the left, and stated that the left knee pain 
had not started until spring 2004.  The Joint Disability Evaluation Tracking System findings from 
March 2005 also indicated that CI’s left knee pain started in spring 2004 and indicated that the 
knee pain was more on the right than the left.  It also noted that the left knee had mild pain, 
minimal  early  degenerative  changes,  and  the  opinion  that  the  left  knee  was  not  separately 
unfitting.  Review of the service treatment record (STR) revealed complaints of bilateral knee 
pain  as  early  as  April  2000  with  range-of-motion  (ROM)  measurements  of  0  to  135  degrees 
bilaterally,  the  same  as  the  ROM  noted  in  January  2005.    A  physical  therapy  (PT)  note  from 
March 2004 also noted left knee pain but no exam of the left knee.  Left knee patellofemoral 
syndrome (PFS) was diagnosed in April 2004 by a primary care provider.  In June 2004, PT noted 
full active ROM of the left knee.  Although patellofemoral syndrome can be unfitting, the CI’s 
left knee injury does not appear to have reached this level of disability prior to separation.  He 
did later have a meniscal tear and chondral fissures of the left knee that required arthroscopy 
but this was not until August 2009, more than 4 years after separation.  After due deliberation, 
the Board agreed that under the reasonably justified standard, the evidence does not support a 
conclusion that left knee pain, as an isolated condition, would have rendered the CI incapable 
of continued service within his rating, and accordingly cannot recommend a separate rating for 
it.   
 
 

   2                                                           PD1100913 
 

Right  Knee  Condition:    There  were  two  goniometric  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.   
                

MEB ~ 5  Mo. Pre-Sep 

VA C&P ~ 1 Mo. Pre-Sep 

Goniometric ROM – 
Right  Knee 
Flexion (140⁰ normal) 
Extension (0⁰ normal) 

Comment 

§4.71a Rating 

joint 

0-135⁰ 
0⁰ 
line  tenderness; 
Lateral 
mild effusion; patellar irritability 
with  significant  quad  inhibition 
that  signifies  painful  motion; 
patellar grind; no instability. 
10% 

0-100⁰ 
0⁰ 
Pain-limited  ROM.  Normal  gait  with  no  signs  of 
abnormal  weight  bearing;  mild  diffuse  tenderness 
over  anterior  and 
lateromedial  aspects;  not 
additionally limited after repeated motion; negative 
drawer and McMurray, no crepitus or ankylosis. 
10% 

 
The MEB narrative summary completed 5 months prior to separation noted that CI’s condition 
started after a right knee twisting injury during PT.  Since that time, he was treated with oral 
medications and PT and ultimately had right knee arthroscopy in December 2003, in which a 
lateral  meniscus  tear  was  found  and  was  debrided.    His  right  knee  pain  worsened  after  said 
surgery  and  he  underwent  another  arthroscopy  in  July  2004  where  the  meniscus  tear  had 
propagated  and  several  loose  bodies  were  found  in  the  right  knee.    The  meniscus  tear  was 
further debrided and the loose bodies were removed at that time.  Subsequently, CI continued 
to  have  right  knee  pain  and  left  knee  pain  emerged  during the  spring of  2004.    X-rays  were 
done  and  showed  early  degenerative  changes  in  both  knees.    At  the  MEB  exam  completed 
approximately 5 months prior to separation, the CI reported that he had pain in both knees, 
right more than left, which prevented him from doing his fitness test, being able to go to the 
rifle range and affected his ability to climb in and out of trucks.  The ROM of the right knee is 
documented  in  the  chart  above.    At  the  VA  Compensation  and  Pension  exam  completed 
approximately  a  month  prior  to  separation,  the  CI  reported  having  bilateral  knee  pain  since 
2001 and the right knee was always worse than the left.  The clinical history of the right knee 
was the same as reported above.  He also reported intermittent stiffness and swelling of the 
right knee.  On examination of the right knee, the VA examiner indicated that there was good 
tone  bilaterally,  good  active  motion,  no  atrophy,  and  strength  was  5/5  throughout.    The  VA 
examiner reported right knee ROM as detailed above.  
 
The Board directs attention to its rating recommendation based on the above evidence.  While 
the PEB utilized 5003 code under the evidence of arthritis in the knees, the VA chose to utilize 
5260 which is driven by pain limited ROM.  However, both assigned a 10% rating.  Neither MEB 
nor  VA  exam  documented  any  other  ratable  criteria  that  can  be  used  to  reach  any  rating 
greater  than  10%.    There  was  no  motor  deficit,  no  neurological  deficit,  and  no  evidence  of 
instability  or  ligamentous  instability  at  the  time  of  separation  from  service.    After  due 
deliberation,  considering  all  of  the  evidence  and  mindful  of  VASRD  §4.3  (Resolution  of 
reasonable  doubt),  the  Board  concluded  that  there  was  insufficient  cause  to  recommend  a 
change in the PEB adjudication.   
 
 
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 
bilateral  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.   
 

   3                                                           PD1100913 
 

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

UNFITTING CONDITION 
Bilateral knee pain 

VASRD CODE  RATING 
5099-5003 
COMBINED 

10% 
10% 

 
 
The following documentary evidence was considered: 
 
Exhibit A.  DD Form 294, dated 20050615, w/atchs 
Exhibit B.  Service Treatment Record 
Exhibit C.  Department of Veterans’ Affairs Treatment Record 
 
 
 
 
 
 
 
 
 

 

           xx 
           Director 
           Physical Disability Board of Review 

   4                                                           PD1100913 
 

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 21 Feb 13 
 

      In accordance with reference (a), I have reviewed the cases forwarded by reference (b), and, for 
the reasons provided in their forwarding memorandum, 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 USN  
-  former USN  
-  former USMC 
-  former USN   
-  former USMC 
-  former USN  
-  former USN   
-  former USN 
-  former USMC 
-  former USMC 
-  former USMC 
-  former USMC 
 
  

 
      
 

 
 
 

 
 
 

 
 
 

 
 
 

  xxxx 
  Assistant General Counsel 
     (Manpower & Reserve Affairs) 

   5                                                           PD1100913