RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXX	CASE:  PD-2014-00013
BRANCH OF SERVICE:  AIR FORCE	BOARD DATE:  20140527
SEPARATION DATE:  20060103

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was a Reserve SRA/E-4 (2T251/Air Transportation Journeyman) medically separated for bilateral knee pain status post bilateral patellar chondroplasty.  The bilateral knee condition could not be adequately rehabilitated to meet the physical requirements of her Air Force Specialty or satisfy physical fitness standards.  She was issued a permanent P4/L4 profile and referred for a Medical Evaluation Board (MEB).  The bilateral knee condition, characterized as “s/p right knee arthroscopy with chondroplasty of the patella” and “left knee chondromalacia,” was the only condition forwarded to the Physical Evaluation Board (PEB) IAW AFI 48-123.  The Informal PEB adjudicated “bilateral knee pain associated with patello-femoral chondromalacia status post bilateral patellar chondroplasty” as unfitting, rated 10%, with likely application of the VA Schedule for Rating Disabilities (VASRD).  The CI made no appeals and was medically separated.

CI CONTENTION:  “I was released from military duties due to my knee and back injuries that I sustained while I was on active duty.  Since then I have had chronic pain and have had multiple surgeries and multiple shots in my knees and still no relief.  Due to my injuries both my knees need a total knee replacement but due to my age the doctors are reluctant to do the procedures so I’m left with a low quality of life and to have chronic pain and I have limitations on everyday things I have to do in life.  So I feel that my percentage I received when I was classified as unfit for military duty should be raised.”

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 bilateral knee condition is addressed below; however, the contended back condition is not 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 Military Records.

RATING COMPARISON:

Service IPEB – Dated 20051114	VA - (5.5 Mos. Post-Separation) 	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Bilateral Knee Pain…	5099-5003	10%	Residuals of Bilateral Knee…	5010	10%*	20060621	
Other x 0 (Not in Scope)	Other x 3		
Rating:  10%	Combined:  30%	
Derived from VA Rating Decision (VARD) dated 20060925 (most proximate to date of separation [DOS]).
VA rated each knee 10% effective 20070312, combined 40%.

ANALYSIS SUMMARY:  The Board acknowledges the CI’s information regarding the significant impairment with which her service-connected condition continues to burden her; but, must emphasize that the Military Disability Evaluation System has neither the role nor the authority to compensate members for anticipated future severity or potential complications of conditions resulting in medical separation.  That role and authority is granted by Congress to the Department of Veterans Affairs (DVA), operating under a different set of laws.  The Board considers DVA evidence proximate 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 to the Board’s recommendations only to the extent that it reasonably reflects the disability at the time of separation.

Bilateral Knee Pain w/Patellofemoral Chondromalacia s/p Bilateral Patellar Chondroplasty.  The CI reported a twisting injury to both knees on 9 October 2003 while working on a cargo pallet.  A magnetic resonance imaging (MRI) on 15 October 2003 noted the presence of minimal degeneration of the cartilage (chondromalacia) of the knee cap (patella) bilaterally.  In both knees, the menisci (cartilage “cushions” in the knee) and ligaments were normal and there was no effusion.  Despite medications, her knee pain continued and she had an injection of the right knee on 23 October 2003.  This provided partial relief and an injection of the left knee was then accomplished on 9 December 2003.  She was seen in orthopedics a week later on 16 December 2003.  She noted a history of knee pain since the prior September (before the injury) and reported that it was worse with going up and down stairs, running, and taking long walks.  On examination, she had full range-of-motion (ROM) and strength bilaterally.  Her knees were stable and meniscal signs absent.  A patellar grind test was positive bilaterally, consistent with the presence of bilateral chondromalacia patella.  She was given a trial oral steroid burst for symptom relief.  This was unsuccessful and she underwent diagnostic and therapeutic arthroscopy of the right knee in April 2004 with chondroplasty (removal of the damaged cartilage and reshaping of the healthy cartilage) of the patella.  She had reduced pain and did well in rehabilitation until she fell down some stairs and landed on her right knee in early October 2004.  Her examination remained normal; she was placed on modified duty.  At a 30 November 2004 follow-up, she reported that the right knee was much improved since the surgery.  Her left knee was bothering her though and a steroid injection was accomplished.  It remained symptomatic and she underwent arthroscopy of the left knee on 9 February 2005 with chondroplasty as well as a lateral release of the patella (a procedure to loosen the tissue anchoring the kneecap to the knee).  She again had improvement, although bilateral knee pain persisted.  On 5 March 2005 the CI was demobilized.  The last orthopedic visit in evidence was on 8 August 2005.  The CI denied locking or giving out, but stated that her left knee sometimes buckled.  Examination showed full ROM without swelling or instability.  Crepitus was present bilaterally.  On 22 August 2005, a permanent L4 profile was issued.  The narrative summary was dated 30 September 2005.  The examiner noted that she was not able to walk or run extended distance (despite treatment) and was not worldwide qualified.  At the VA Compensation and Pension examination performed 5 months after separation, the CI reported that she was self-employed and that her knee condition did not impair her occupational function.  She reported that she generally could walk “OK” and took non-narcotic pain relievers.  Examination of the knees showed no swelling or effusion, instability, or meniscal irritation.  The ROM was full.  Crepitus was present.  Painful motion was not documented.

The Board directs attention to its rating recommendation based on the above evidence.  The PEB coded the bilateral knee condition as 5099-5003, analogous to degenerative arthritis and rated the bundled knee condition at 10%.  The VA also combined the knees for a single 10% rating, but used the 5010 code for traumatic arthritis.  The VA subsequently rated each knee at 10%, effective on 12 March 2007, over a year after separation and continued the 5010 code.  The Board considered if each knee was separately unfitting.  Both had surgery with chondroplasty.  Both were treated with injections after the surgery.  Both had abnormal findings on MRI.  The Board considered that the evidence could support a finding that each knee was separately unfitting.  However, the Board then considered the coding options for the knees and determined that absent instability, incapacitation, subluxation, meniscal injury, painful motion, or limitation in motion, none provided a route to a rating higher than the 10% adjudicated by the PEB for the bilateral knee condition.  As this provides no benefit to the CI, no change in the PEB adjudication is recommended.  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 for the bilateral knee 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 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.

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

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20131230, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans’ Affairs Treatment Record

		
XXXXXXXXXXXXXX
President
Physical Disability Board of Review

SAF/MRB

Dear XXXXXXXXXXXXXX:

	Reference your application submitted under the provisions of DoDI 6040.44 (Title 10 U.S.C. §  1554a), PDBR Case Number PD-2014-00013.

	After careful consideration of your application and treatment records, the Physical Disability Board of Review determined that the rating assigned at the time of final disposition of your disability evaluation system processing was appropriate.  Accordingly, the Board recommended no re-characterization or modification of your separation.

	I have carefully reviewed the evidence of record and the recommendation of the Board.    I concur with that finding and their conclusion that re-characterization of your separation is not warranted.  Accordingly, I accept their recommendation that your application be denied.

							Sincerely,

XXXXXXXXXXXXXX
Director
Air Force Review Boards Agency

Attachment:
Record of Proceedings