RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXX	CASE:  PD-2014-00280
BRANCH OF SERVICE:  AIR FORCE 	SEPARATION DATE:  20060213

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E-4 (Security Forces Journeyman) medically separated for right knee pain.  The condition could not be adequately rehabilitated to meet the physical requirements of his Air Force Specialty (AFS) or satisfy physical fitness standards.  He was issued a series of temporary L4 profiles and eventually referred for a Medical Evaluation Board (MEB).  The “chronic right knee pain, status post anterior cruciate ligament reconstruction and meniscectomy with normal exam” was forwarded to the Physical Evaluation Board (PEB) IAW AFI 48-123.  No other condition was submitted by the MEB.  The Informal PEB adjudicated his right knee pain as unfitting, rated 10%, citing application of the Veterans Affairs Schedule for Rating Disabilities (VASRD).  The CI made no appeals and was medically separated. 

CI CONTENTION:  “Member was injured during deployment training.  Later member separated due to medical condition.”  His complete submission, with attachment, is at Exhibit A.

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 when specifically requested by the CI, those conditions identified by the PEB, but determined to be not unfitting.  Any conditions outside the Board’s defined scope of review and any contention not requested in this application may remain eligible for future consideration by the Board for Correction of Military/Naval Records.  Furthermore, the Board’s authority is limited to assessing the fairness and accuracy of PEB rating determinations and recommending corrections, where appropriate.  The Board’s assessment of the PEB rating determinations is confined to review of medical records and all available evidence for application of the VASRD standards to the unfitting medical condition at the time of separation.  The Board has neither the role nor the authority to compensate for post-separation progression or complications of service-connected conditions.  That role and authority is granted by Congress to the Department of Veterans Affairs, operating under a different set of laws.  The Board gives consideration to VA evidence, particularly within 12 months of separation, but only to the extent that it reasonably reflects the severity of the disability at the time of separation. 

RATING COMPARISON:  

IPEB – Dated 20051220	VA* - (~6 Mos. Post-Separation)  	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Right Knee Pain…	5299-5257	10%	Right Knee, ACL Tear, S/P Repair	5299-5257	10%	20060817	
Other x 0 (Not In Scope)	Other x 2	
RATING:  10%	RATING:  10%	
*Derived from VA Rating Decision (VARD) dated 20061205 (most proximate to date of separation (DOS)).  

ANALYSIS SUMMARY:    

Right Knee Condition.  The CI twisted his right knee on 12 November 2003 and was initially treated conservatively with medications, a brace, and partial weight bearing.  His symptoms persisted and he was found to have tears of the anterior cruciate ligament (ACL, an internal knee ligament which provides stability) and medial and lateral menisci (internal knee cartilage cushions).  These were repaired surgically on 30 January 2004.  Despite rehabilitation, he continued to have knee pain and remained on a profile for over a year which then triggered an MEB.  The narrative summary (NARSUM) was dated 21 September 2005, 5 months prior to separation, and recorded that the range-of-motion (ROM) was intact, the knee stable, and signs of meniscal irritation absent.  The CI reported that he could not stand for long periods, run, or wear combat gear secondary to knee pain.  Either cross-training or separation was recommended.  The CI was seen 2 months later in orthopedics and his examination remained normal.  At the VA Compensation and Pension (C&P) exam performed 6 months after separation, the CI reported persistent knee pain.  His gait was normal and the knee was stable.  The ROM was slightly reduced as charted below.  Signs of meniscal irritation were absent and the knee was stable.  X-rays were normal and the knee was thought to cause no significant impairment.  The goniometric 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
(Degrees)	MEB ~5 Mo. Pre-Sep	VA C&P ~6 Mo. Post-Sep	
Flexion (140 Normal)	Range of Motion 
was intact	120	
Extension (0 Normal)		-10 	
Comment	Painful motion not recorded	Nml gait; painful motion	
§4.71a Rating	0%	10%	

The Board directed its attention to its rating recommendation based on the above evidence.  The PEB and VA both rated the knee 10%, coded 5299-5257 (analogous to other impairment of the knee).  The Board considered the findings and found no route to a rating higher than that adjudicated by the PEB.  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 adjudication for the right 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 right 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 20131216, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

SAF/MRB
1500 West Perimeter Road, Suite 3700
Joint Base Andrews, MD  20762

Dear XXXXXXXXXXXXXXX:

Reference your application submitted under the provisions of DoDI 6040.44 (Section 1554, 10 USC), PDBR Case Number PD-2014-00280

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,

Attachment:
Record of Proceedings