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AF | PDBR | CY2013 | PD2013 00064
Original file (PD2013 00064.rtf) Auto-classification: Denied
RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME: xx.        CASE: PD1300064
BRANCH OF SERVICE: marine corpS  BOARD DATE: 20130514
SEPARATION DATE: 20020325


SUMMARY OF CASE: Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty CPL/E4 (2311/Ammunitions Technician) medically separated for left knee pain. He had a history of left knee pain which began in March 2000. He underwent an anterior ligament reconstruction after diagnosis but postoperatively was noncompliant with his rehabilitation. Despite repeat surgical intervention and therapy the condition could not be adequately rehabilitated to meet the physical requirements of his Military Occupational Specialty or satisfy physical fitness standards. He was placed on limited duty and referred for a Medical Evaluation Board (MEB). The left knee pain condition, characterized as “pain in joint involving lower leg,” was forwarded to the Physical Evaluation Board (PEB) IAW SECNAVINST 1850.4E. No other conditions were submitted by the MEB. The PEB adjudicated “anterior knee pain after left anterior cruciate ligament (ACL) reconstruction” as unfitting, rated 10%, with application of the Veterans Affairs Schedule for Rating Disabilities (VASRD). The condition “no evidence of ligamentous instability in the left knee” was determined to be Category III (not separately unfitting and do not contribute to the unfitting condition). The CI made no appeals, and was medically separated.


CI CONTENTION: “The condition has not improved since discharge. Since discharge I have been issued a disability parking permit due to pain from walking and standing too long.”


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. Ratings for unfitting conditions will be reviewed in all cases. The rated, unfitting left knee condition meets the criteria prescribed in DoDI 6040.44 for Board purview. 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 20020312
 VA - (9 mos Post-Separation) -
Condition
 Code Rating Condition Code Rating Exam
Anterior Knee Pain After Left ACL Reconstruction 5010-5003 10% Left Knee ACL repair 5257-5010 10% 20021223
No Evidence of Ligamentous Instability In the Left Knee CAT III
No Additional MEB/PEB Entries
 Other x 3 20021223
Combined: 10%
 Combined: 10%
Derived from VA Rating Decision (VARD) dated 200 30114 (most proximate to date of separation [DOS]).




ANALYSIS SUMMARY: The Disability Evaluation System (DES) is responsible for maintaining a fit and vital fighting force. While the DES considers all of the 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. The DES has neither the role nor the authority to compensate members for anticipated future severity or potential complications of conditions resulting in medical separation nor for conditions determined to be service-connected by the Department of Veteran Affairs (DVA) but not determined to be unfitting by the PEB. However the 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’s role is confined to the review of medical records and all evidence at hand to assess the fairness of PEB rating determinations, compared to VASRD standards, based on severity at the time of separation.

Left Anterior Knee Pain Condition. The CI injured his left knee in June 2000 while playing volleyball resulting in torn anterior cruciate ligament. The CI underwent surgical repair of the torn ACL on 11 August 2000 with good recovery. Physical therapy examinations in November and December 2000 recorded full active range-of-motion (ROM), normal gait, and no instability (negative Lachman test). The CI subsequently complained of anterior left knee pain limiting running and other vigorous activities. Diagnostic arthroscopy on 13 July 2001 demonstrated a normal intact ACL graft, intact menisci, unremarkable patella but scar tissue within the anterior aspect of the knee. There was a tight band of scar tissue extending from meniscal region to the patellar fat pad which was surgically released. Physical therapy examination 8 August 2001 recorded normal ROM with mild weakness of the knee extensors. There was no ligamentous instability. The orthopedic MEB narrative summary examination 19 November 2001, recorded full motion. There was no instability and examination of ligaments of the left knee was symmetrical compared to the uninjured left knee. There was no swelling, joint line tenderness or meniscus signs or symptoms. At the VA Compensation and Pension examination 23 December 2002, 9 months after separation, the CI reported pain in the left knee with change of temperature. Examination showed some tenderness and swelling of the lateral aspect of the left knee, there was no evidence of crepitation. Left knee extension was 0 degrees and flexion 120 degrees (normal 140).

The Board directs attention to its rating recommendation based on the above evidence. Both the PEB and the VA rated the condition as 10% for painful motion of a major joint with similar coding (5010-5003 and 5257-5010 respectively). There was no limitation of motion that attained a minimum rating under the diagnostic codes for limitation of motion (5260 flexion, 5261 extension). There was no instability or meniscus pathology for ratings under the respective codes (5257, 5258, 5259). There was however sufficient evidence to support a 10% rating considering painful motion (§4.59,) and functional loss (§4.40). After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the Board concluded that there was insufficient cause to recommend a change in the PEB adjudication of the chronic left knee pain 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. In the matter of the left anterior knee pain 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.

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

UNFITTING CONDITION
 VASRD CODE RATING
Left Anterior Knee Pain, s/p ACL Repair 5010-5003 10%
COMBINED
 10%


The following documentary evidence was considered:

Exhibit A. DD Form 294, dated 20120817, w/atchs
Exhibit B. Service Treatment Record
Exhibit C. Department of Veterans’ Affairs Treatment Record






         xx
         President
         Physical Disability Board of Review


 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 15 Jul 13

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


                                                      xx
                                                     Assistant General Counsel
                                                      (Manpower & Reserve Affairs)

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