RECORD OF PROCEEDINGS 

PHYSICAL DISABILITY BOARD OF REVIEW 

      

BRANCH OF SERVICE:  MARINE CORPS  
SEPARATION DATE:  20040215 

 
NAME:                  
CASE NUMBER:  PD1200784                            
BOARD DATE:  20121205   
 
 
SUMMARY  OF  CASE:    Data  extracted  from  the  available  evidence  of  record  reflects  that  this 
covered  individual  (CI)  was  an  active  duty  LCpl,  /E-4  (1341/Engineer  Equipment  Mechanic), 
medically separated for a right knee and associated right lower leg condition.  The CI had non-
traumatic onset of right knee pain, swelling and giving way/locking in 2000.  Radiographs and 
magnetic resonance imaging (MRI) demonstrated right knee bony abnormality (femoral condyle 
osteochondritis  dissecans)  and  possible  meniscal  injury.    The  CI  underwent  right  knee 
arthroscopic surgery with plica repair, and repair (debridement and drilling) of bony lesions on 
the femur and tibia.  The CI had a post-operative deep venous thrombosis (DVT) which required 
anticoagulation and delayed rehabilitation of the knee.  The CI was placed on limited duty, the 
DVT resolved and the CI was taken off of anticoagulant therapy.  The right knee could not be 
adequately  rehabilitated  to  meet  the  physical  requirements  of  his  Military  Occupational 
Specialty  (MOS)  or  satisfy  physical  fitness  standards.    He  was  consequently  referred  for  a 
Medical Evaluation Board (MEB).  The right knee/lower extremity condition, characterized as 
“right medial femoral condyle osteochondritis dissecans lesion status post surgical debridement 
and drilling, and right knee symptomatic medial plica status post surgical debridement;” and 
the right lower extremity DVT condition were forwarded to the Physical Evaluation Board (PEB).  
The PEB adjudicated the right medial femoral condyle condition as unfitting, rated 10%, citing 
criteria  of  the  Veterans  Administration  Schedule  for  Rating  Disabilities  (VASRD).    The  PEB 
included the right knee plica condition as a Category II diagnosis; a condition contributing to the 
unfitting  medial  femoral  condyle  condition.    The  DVT  condition  was  determined  to  be  not 
unfitting.  The CI made no appeals, and was medically separated with A 10% disability rating.   
 
 
CI CONTENTION:  The application states in part “My knee that carries the 10% disability rating 
should have been 30% due to the fact that I was using a brace and a cane.  My medical records 
will  show  that  a  hole  was  drilled  into  my  femur  bone  which  never  healed.    Dropping  bone 
fragments into the joint I have torn my meniscus.  I have a number of other disabilities that I 
claimed that were (skipped over) during my exam on Camp Lejeune…”  (sic) The CI goes on at 
length to claim the following conditions:  neck, right foot, left thumb, dysautonomia, tinnitus, 
and gastric problems.  The application was accompanied by a four page letter from the CI which 
detailed  the  aforementioned  conditions  and  associated  symptoms  as  well  as  claimed 
headaches,  chest  pain,  “botched  surgery”  and  DES  irregularities.    The  accompanying  letter 
specifically contends the deep venous thrombosis condition.  The letter was reviewed by the 
Board and considered in its recommendations.   
 
 
SCOPE  OF  REVIEW:    The  Board  wishes  to  clarify  that  the  scope  of  its  review  as  defined  in 
Department of Defense Instruction (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  right  knee  (all  aspects)  and  the  right  leg  DVT 
conditions  as  requested  for  consideration  meet  the  criteria  prescribed  in  DoDI  6040.44  for 
Board purview; and, are addressed below, in addition to a review of the ratings for the unfitting 
right medial femoral condyle condition.  All other conditions contended by the CI are excluded 
from scope as these conditions were not mentioned by the PEB.  Any other conditions intended 

Right Medial Femoral 
Condyle Osteochondritis 
Dissecans Lesion …  
Right Knee Symptomatic 
Medial Plica … 
Right Lower Extremity 
Postoperative DVT 

5299-5003 

10% 

Cat II 

Not Unfitting 

↓No Additional MEB/PEB Entries↓ 

Status Post Arthroscopic Surgery 
Right Knee 

5003-5260 

10%* 

STR 
then 

20041201 

7199-7121 

NSC 

STR 

Status Post Deep Venous 
Thrombosis Right Leg 
Mood Disorder with Anxiety and 
Panic Attacks 
Left Thumb Numbness 
Tinnitus 
GERD 
Sinusitis 

9499-9435 

8614 
6260 

6513 

7399-7346 

Not Service Connected x 15 

Combined:  50%* 

10%* 
20% 
10% 
10% 
0%* 

20060224 
20041201 
20060203 
20041201 
20060224 

2004-
2011 
various 

in request for Board consideration, or any condition or contention outside the Board’s defined 
scope of review, remain eligible for future consideration by the Board for Correction of Naval 
Records (BCNR).   
 
 
RATING COMPARISON:   
 

Service IPEB – Dated 20031210 
Condition 

Code 

VA (STR + 10 Mo. Post-Separation) – Effective 20040216 

Rating 

Condition 

Code 

Rating 

Exam 

Combined:  10% 

*Note:  R knee (VA code 5003-5260) increased to 30% from 20090316; VA code 9499-9435 increased to 70% from 20081019; 
VA code 6513 increased to 10% from 20090316; combined disability increased to 80% from 20081019; 90% from 20090316; 
Individual Unemployability granted from 20081019.   
 
 
ANALYSIS SUMMARY:  The disability picture of the right knee was considered in its entirety as it 
is a single major joint and the symptoms for both right medial femoral condyle osteochondritis 
dissecans 
lesion  and  the  associated  Category  II  right  knee  symptomatic  medial  plica 
debridement are not separable from a fitness or functional perspective.   
 
The  Board  acknowledges  the  CI's  contention  suggesting  that  ratings  should  have  been 
conferred  for  other  conditions  documented  at  the  time  of  separation,  some  of  which  were 
evaluated  and  determined  not  to  be  individually  unfitting  for  continued  service.    The  Board 
wishes to clarify that it is subject to the same laws for disability entitlements as those under 
which the Disability Evaluation System (DES) operates.  The DES is responsible for maintaining a 
fit  and  vital  fighting  force.    While  the  DES  considers  all  of  the  service  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.  However the Department of Veterans Affairs (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  is 
empowered to evaluate the fairness of fitness determinations, and to make recommendations 
for  rating  of  conditions  which  it  concludes  would  have  independently  prevented  the 
performance  of  required  duties  (at  the  time  of  separation).    The  Board’s  threshold  for 
countering  DES  fitness  determinations  is  higher  than  the  VASRD  §4.3  (reasonable  doubt) 
standard used for its rating recommendations, but remains adherent to the DoDI 6040.44 “fair 
and equitable” standard.   
 
The  Board  also  acknowledges  the  CI’s  opinion  that  a  medical  error  (“botched  surgery”)  was 
responsible for his disability, with the implication that the disability rating should provide for 
remedy.    It  must  be  noted  for  the  record  that  the  Board  has  neither  the  jurisdiction  nor 

   2                                                           PD1200784 
 

authority  to  scrutinize  or  render  opinions  in  reference  to  allegations  regarding  suspected 
improprieties  or  faulty  medical  care.    The  Board’s  role  is  confined  to  the  review  of  medical 
records  and  all  evidence  at  hand  to  assess  the  fairness  of  PEB  disability  ratings  and  fitness 
determinations  as  elaborated  above. 
  Redress 
in  excess  of  the  Board’s  scope  of 
recommendations must be addressed by the BCNR.   
 
Right Medial Femoral Condyle Osteochondritis Dissecans Lesion and Right Knee Plica Condition.  
The goniometric range-of-motion (ROM) evaluations in evidence which the Board weighed in 
arriving  at  its  rating  recommendation,  with  documentation  of  additional  ratable  criteria,  are 
summarized in the chart below.   
 

Right Knee ROM 

(In degrees) 

Flexion (140 Normal) 
Extension (0 Normal) 

Comment:   

Surgery ~9 Mo. Pre-Sep 

§4.71a Rating 

VA C&P ~10 Mo. Post-Sep 
Normal (see comments) 
Normal (see comments) 
Gait normal; “flare-ups 

requires use of a cane” ; “… 
additional 5⁰ of limitation due 
to pain and weakness when 
climbing stairs”; no brace 

10% 

PT ~5 Mo. Pre-Sep 

MEB ~4.5 Mo. Pre-Sep 

116 
2 

115 
0 

Motor Quad function 
4/5; + effusion; knee 
brace; 4 Mo. post-

surgery 
10%-20% 

asymmetric; 

Quad  and  calf  muscle  mass 
slightly 
5/5 
strength; 
stable 
Lachman exam and varus and 
valgus; 5 Mo. post-surgery 

TTP; 

10% 

 
The narrative summary (NARSUM) documented the history described above, with post-surgical 
“medial pain in the right knee with weightbearing activities that necessitate his walking with a 
cane.”    The  exam  is  summarized  above  and  radiographs  indicated  medial  femoral  condyle 
osteochondritis dissecans lesion still visible with some interval filling since pre-operative exam.  
The  VA  Compensation  and  Pension  (C&P)  exam  performed  10  months  after  separation 
indicated a normal exam with normal gait, with the examiner indicating additional limitation 
due to pain as summarized above.  A VA exam that was over 3 years remote from separation 
indicated an antalgic gait, with complaints of locking and gives way, and pain limited flexion on 
repetition.  The VA continued their 10% rating following that exam.   
 
The Board directs attention to its rating recommendation based on the above evidence.  The 
PEB  rated  the  “right  medial  femoral  condyle  osteochondritis  dissecans  lesion  status  post 
surgical  debridement  and  drilling  as  5299-5003  with  an  associated  category  II  right  knee 
symptomatic medial plica status post surgical debridement.”  The VA rated the entire right knee 
condition, based on the service treatment records alone (as the CI missed his VA exam), at 10% 
under code 5003-5260 (Leg, limitation of flexion).  The VA continued the 10% rating after the 
post-separation VA exam summarized above.  All ROMs proximate to separation would support 
no  higher  than  a  10%  rating  regardless  of  coding  choice.    The  plica  condition  has  similar 
characteristics  to  meniscal  tears  and  analogous  meniscal  coding  was  evaluated.    The  Board 
deliberated regarding alternate analogous coding using 5258 (Cartilage, semilunar, dislocated), 
however there was insufficient evidence of instability or "frequent episodes of “locking,” pain, 
and effusion into the joint" to warrant a 20% rating.  Although analogous coding to 5259 could 
be supported, it would be at the 10% level and offer no benefit to the CI as meniscal coding 
includes painful motion and dual coding was not indicated.  Given the tibial bone defect and 
surgery the Board also considered analogous coding under 5262 (Tibia and fibula, impairment) 
with  knee  disability  and  deliberated  if  the  disability  picture  more  nearly  represented  the 
moderate (20%) knee disability level.   
 
After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable 
doubt), the Board majority concluded that there was insufficient cause to recommend a change 
in  the  PEB  adjudication  of  the  right  medial  femoral  condyle  osteochondritis  dissecans  lesion 
with right knee plica condition.   

   3                                                           PD1200784 
 

Contended Right Lower Extremity Postoperative DVT Condition.  The Board’s main charge with 
respect to this condition is an assessment of the fairness of the PEB’s determination that it was 
not unfitting.  The Board’s threshold for countering fitness determinations is higher than the 
VASRD  §4.3  (reasonable  doubt)  standard  used  for  its  rating  recommendations,  but  remains 
adherent to the DoDI 6040.44 “fair and equitable” standard.  The deep vein thrombosis (DVT) 
condition was part of the CI’s LIMDU; it was not specified in the non-medical assessment (NMA) 
commander’s statement; but,  it was  considered to adversely impact retention as it carried a 
risk of recurrence.  The CI had no recurrent DVTs, no pulmonary embolus symptoms or lower 
leg/calf residuals that would rise to the level of unfitting proximate to separation.  History of 
postoperative right leg DVT was reviewed by the action officer and considered by the Board.  
There was no performance based evidence from the record that the DVT condition significantly 
interfered with satisfactory duty performance.  After due deliberation in consideration of the 
preponderance  of  the  evidence,  the  Board  concluded  that  there  was  insufficient  cause  to 
recommend a change in the PEB fitness determination for the DVT condition; thus no additional 
disability rating can be recommended.   
 
 
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  or  PEB  ruling  in  this  case  that  any  prerogatives  outside  the  VASRD 
were exercised.  In the matter of the right medial femoral condyle osteochondritis dissecans 
lesion  with  right  knee  plica  condition  and  IAW  VASRD  §4.71a,  the  Board  by  a  vote  of  2:1 
recommends  no  change 
in  the  PEB  adjudication.  The  single  voter  for  dissent  (who 
recommended a 20% rating coded 5003-5262) did not elect to submit a minority opinion.  In 
the  matter  of  the  contended  right  lower  extremity  postoperative  DVT  condition,  the  Board 
unanimously agrees that it cannot recommend it for additional disability rating.  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 

Right Medial Femoral Condyle Osteochondritis Dissecans Lesion 
with Medial Plica Repair 

VASRD CODE  RATING 
5299-5003 
COMBINED 

10% 
10% 

 
 
The following documentary evidence was considered: 
 
Exhibit A.  DD Form 294, dated 20120606, w/atchs. 
Exhibit B.  Service Treatment Record. 
Exhibit C.  Department of Veterans Affairs Treatment Record. 
 
 
 
 
 
 
 
 

 

             
           President 
           Physical Disability Board of Review 

   4                                                           PD1200784 
 

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 31 Dec 12 
 
      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 USMC  
-  former USMC  
 
-  former USN 
 
 
-  former USMC 
 
-  former USMC  
 
 
 
 
 
 
 

  
Assistant General Counsel 
 (Manpower & Reserve Affairs) 

 
      
 

   5                                                           PD1200784