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AF | PDBR | CY2013 | PD-2013-01965

Original file (PD-2013-01965.rtf) Auto-classification: Denied

RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME: XXXXXXXXXXXXXX CASE: PD -20 13 - 0 1965
BRANCH OF SERVICE: MARINE CORPS BOARD DATE: 2014 1021

Separation Date: 20051215

SUMMARY OF CASE : Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty PFC/E-2 (3531/Motor Operator) medically separated for left knee injury. The condition could not be adequately rehabilitated to meet the physical requirements of her Military Occupational Specialty or satisfy physical fitness standards. She was placed on limited duty [LIMDU] for 8 months and referred for a Medical Evaluation Board (MEB). The left knee injury conditions, characterized as “rupture of tendon, nontraumatic” and “old disruption of anterior cruciate ligament (ACL)” and “chondromalacia of patella” and “unspecified orthopedic aftercare,” were forwarded to the Physical Evaluation Board (PEB) IAW SECNAVINST 1850.4E. No other conditions were submitted by the MEB. The Informal PEB adjudicated “status post [s/p] left ACL” as unfitting, rated 0% with likely application of VA Schedule for Rating Disabilities (VASRD). The remaining conditions were characterized as Category II (conditions that contribute to the unfitting condition) as listed in chart below. The CI made no appeals and was medically separated.

CI CONTENTION : “My condition is one that is progressively getting worse. It is not going to get better.”

SCOPE OF REVIEW : The Board’s scope of review is defined in DoDI 6040.44, Enclosure 3, paragraph 5.e.(2). It is limited to those conditions determined by the PEB to be unfitting for continued military service and those conditions identified but not determined to be unfitting by the PEB when specifically requested by the CI. The rating for the unfitting s/p left ACL reconstruction condition is addressed below; no additional conditions are within the DoDI 6040.44 defined purview of the Board. 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 20051031	VA - No C&P Exam in Evidence
Condition	Code	Rating	Condition	Code	Rating	Exam
Left ACL Reconstruction	5299-5003	0%	NO VA ENTRY
Left Knee Grade II Chondromalacia Patellae	CAT II	NO VA ENTRY
s/p Left Patellar Tendon Repair	CAT II	NO VA ENTRY
Left ACL Tear	CAT II	NO VA ENTRY
Left Knee Patellar Tendon Rupture	CAT II	NO VA ENTRY
Other x 0 (Not in Scope)
Combined: 0%	Combined: -

ANALYSIS SUMMARY : The Board acknowledges the sentiment expressed in the CI’s application regarding the significant impairment with which h er service-incurred condition continues to burden h er . 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. The Board’s authority as defined in DoDI 6044.40, however, resides in evaluating the fairness of the Disability Evaluation System fitness determinations and rating decisions for disability at the time of separation. It appears the CI did not did receive a VA rating decision or undergo a VA Compensation & Pension (C&P) examination for her left knee condition. Members deliberated if this negatively impacted their ability to render a fair assessment and agreed that the available evidence was sufficiently probative; evidence presumed not accomplished would not materially affect the Board’s final recommendation.

The PEB coded the l eft k nee Grade II c hondromalacia p atellae s / p l eft p atellar t endon r epair , l eft ACL t ear and l eft k nee p atellar t endon r upture conditions as Category II (c onditions that contri bute to the unfitting condition ) . These conditions will be discussed together under the s/p l eft ACL r econstruction condition .

Left ACL Reconstruction Condition . There were two 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)	PT ~5.5 Mos. Pre-Sep	NARSUM ~3 Mos. Pre-Sep
Flexion (140 Normal)	130	130
Extension (0 Normal)	0	0
Comment	Mild effusion with quadriceps atrophy; No Pain	Small effusion with quadriceps atrophy; No instability
§4.71a Rating	10%	10%

invalid font number 31502

The CI underwent the following surgeries:
1.

Left knee repair of patellar tendon avulsion 7 September 2004
2. Arth roscopy Left ACL reconstruction 19 April 2005

The CI injured her left knee and sustained a patellar tendon rupture and ACL tear during a dirt bike accident in September 2004. A left knee X -ray was suggestive of a n infrapa tellar tendon rupture with a detachment of a small bone fragment and an avulsion of a small bone fragment from the lateral aspect of the proximal tibia, most likely related to a capsular tear. The CI underwent a left knee repair of the patellar tendon avulsion on 7 September 2004. The physical therapist noted that the CI had left knee ache and pain at night with physical exam find ings of tenderness to palpation and hypersensitivity at the patellar tendon incision, full ROM, positive Lachman’s and a mild effusion. The CI was placed on the first 8 - month LIMDU on 19 November 2004 for recovery from the patellar tendon repair. The o rthopedist noted that the CI required a knee immobilizer, crutches and pain medication. A magnetic resonance imaging showed a partial tear in the distal medial collateral ligament, a tear in the ACL and a tear in the body, anterior horn and posterior horn of the lateral meniscus. The CI underwent l eft ACL reconstruction on 19 April 2005 where no meniscal damage was found . The CI continued to follow with o rthopedics throughout 2005 and was noted to have an ongoing small effusion and limited ROM on flexion. The CI was placed on a second LIMDU for 5 months due to left knee weakness and time for recovery from the two left knee surgeries which started on 19 July 2005. The o rthopedist noted quad weakness, soreness and an inability to run and physical findings of ROM flexion 0-130 with slight laxity with endpoint. The MEB n arrative s ummary (NARSUM) exam completed approximately 2 months prior to separation documented that the CI was still unable to regain full quadriceps strength and was unable to run. The MEB NARSUM physical exam findings were summarized in the chart above. There was no VA C&P exam completed.

The Board directs attenti on to its rating recommendation based on the above evidence . The PEB coded the s / p l eft ACL r econstruction condition as 5299 analogous to 5003 a rthritis, degenerative (hypertrophic or osteoarthritis) and rated at 0%. No exam documented limited ROM to a compensable level or the presence of painful motion to allow for the application of VASRD §4.59. VASRD codes 5257, 5258 and 5259 require knee instability, meniscal pathology or symptomatic meniscal removal, none of which were present in this case. The Board considered cod e 52 62 ( impairment of the tibia/fibula ) , giving consideration to the well documented effusion and resulting mild quadriceps atrophy and members agreed that that code represents the best coding/rating option. Code 5262 requires a subjective estimation of the disability present for the slight, moderate or marked rating levels. Board members agreed that the ROM measurements, small effusion, quadriceps atrophy with weakness were most consistent with a mild disability of the knee. After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the Board recommends a disability rating of 10 % for the s/p l eft ACL r econstruction 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. 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 s/p l eft ACL r econstruction condition, the Board unanimously recommends a disability rating of 10 % coded 5 2 99-5 262 IAW VASRD §4.71a. There were no other conditions within the Board’s scope of review for consideration.

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

UNFITTING CONDITION	VASRD CODE	RATING
s/p Left Anterior Cruciate Ligament Reconstruction	5 2 99-5 262	1 0%
COMBINED	1 0%

The following documentary evidence was considered:

Exhibit A. DD Form 294, dated 20 131023 , w/atchs
Exhib it B. Service Treatment Record
Exhibit C. Department of Veterans ’ Affairs Treatment Record

XXXXXXXXXXXXXX
President

Physical Disability Board of Review

MEMORANDUM FOR COMMANDER, NAVY PERSONNEL COMMAND
                  DEPUTY COMMANDANT, MANPOWER & RESERVE AFFAIRS

Subj: PHYSICAL DISABILITY BOARD OF REVIEW (PDBR) RECOMMENDATIONS

Ref: (a) DoDI 6040.44
(b) PDBR ltr dtd 14 Apr 15 ICO XXXXXXXXXXXXXXX
         (c) PDBR ltr dtd 7 Apr 15 ICO XXXXXXXXXXXXXXX
         (d) PDBR ltr dtd 14 Apr 15 ICO XXXXXXXXXXXXXXX
         (e) PDBR ltr dtd 14 Apr 15 ICO XXXXXXXXXXXXXXX
(f) PDBR ltr dtd 21 Apr 15 ICO XXXXXXXXXXXXXXX

1. Pursuant to reference (a) I approve the recommendations of the Physical Disability Board of Review set forth in references (b) through (f).

2. The official records of the following individuals are to be corrected to reflect the stated disposition:

a. XXXXXXXXXXXXXXX, former USN: Entitlement to disability severance pay with a disability rating of 20 percent (increased from 10 percent) effective date of discharge.

b. XXXXXXXXXXXXXXX, former USMC: Entitlement to disability severance pay with a disability rating of 20 percent (increased from 0 percent) effective date of discharge.

c. XXXXXXXXXXXXXXX, former USMC: Entitlement to disability severance pay with a disability rating of 20 percent (increased from 10 percent) effective date of discharge.

d. XXXXXXXXXXXXXXX, former USMC: Entitlement to disability severance pay with a disability rating of 10 percent (increased from 0 percent) effective date of discharge.

e. XXXXXXXXXXXXXXX, former USN: Retroactive placement on the Temporary Disability Retired List with a disability rating of 50 percent for the 6 months immediately preceding discharge followed by disability separation effective date of discharge with a 10 percent disability rating.

3. Please ensure all necessary actions are taken to implement these decisions, including the recoupment of disability severance pay, if warranted, and notification to the subject members once those actions are completed.

         XXXXXXXXXXXXXXX
         Assistant General Counsel

(Manpower & Reserve Affairs)

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AF | PDBR | CY2013 | PD-2013-01965

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