RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXXX	CASE:  PD-2014-00717
BRANCH OF SERVICE:  AIR FORCE	BOARD DATE:  20141219
SEPARATION DATE:  20070521

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 or satisfy physical fitness standards.  He was issued a temporary L4 profile and referred for a Medical Evaluation Board (MEB).  The right knee pain condition, characterized as “right knee pain” was forwarded to the Physical Evaluation Board (PEB) IAW AFI 48-123.  No other conditions were submitted by the MEB.  The Informal PEB adjudicated “right knee pain, status-post right anterior cruciate ligament and meniscus repair” rated 20% with application of the VA Schedule for Rating Disabilities (VASRD).  The CI made no appeals and was medically separated.

CI CONTENTION:  he continues to suffer pain from his condition.  He is unable to run, jump, kneel or squat.  Surgery is expected in the near future.  His complete submission 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 Veterans Affairs Schedule for Rating Disabilities (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:

Service IPEB – Dated 20070409	VA* - (3 Mo. Post-Separation)	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Right Knee Pain	5257	20%	Ligamentary Laxity and Instability of the Right Knee	5257	10%	20070818	
			Residuals of a Right Knee Injury, Status Post ACL Reconstruction and Partial Menisectomy…	5261	10%	20070818	
Other x 0  (Not in Scope)	Other x 0	
Combined:  20%	Combined:  20%	
*Derived from VA Rating Decision (VARD) dated 20070926 (most proximate to date of separation (DOS))

ANALYSIS SUMMARY:

Right Knee Pain Condition.  The narrative summary (NARSUM) noted the CI suffered an injury to his right knee during physical training.  Instability of the knee developed and a magnetic resonance imaging revealed a tear of the anterior cruciate ligament (ACL) ligament.  This was surgically repaired in January 2006.  The condition resolved, but the CI slipped on ice after rehabilitation and sustained an incomplete tear of a lateral meniscus in the same knee.  This could not be successfully rehabilitated and required surgical repair in September of 2006.  Following this surgery a chronic knee pain condition developed with associated subjective feelings by the CI of the knee “giving way.”  On physical therapy (PT) evaluation on 25 January 2007, the CI was wearing an ACL brace, which allowed him to do “various activities.”  His gait was described as “functional.”  Range-of-motion (ROM) of the knee was flexion of 130 degrees and extension of 0. (normal:  140 and 0 respectfully).  The CI was noted to be unable to rise from a squat because of “locking of his knee.”  On PT evaluation performed on 7 February 2007, the CI reported continued difficulties with his knee “giving way” and “popping.”  At the MEB NARSUM evaluation on 7 February 2007, 3 months prior to separation, the CI reported continued weakness and “instability” of the knee.  The MEB physical exam noted the knee to be “globally tender” to palpation but to have no swelling.  ROM revealed flexion of 132 degrees and extension of 0 when assisted with heel slide with no mention of pain.  Motor and sensory exams were normal.  No clinical evaluation of stability was recorded but the examiner reporting that “the CI still has perceived instability.”  The examiner opined that the CI had “chronic joint pain and instability.”

At the VA Compensation and Pension (C&P) exam performed on 18 August 2007, 3 months after separation, the CI reported the knee condition to prevent participation in sports, to have a “moderate” impact on exercise but no impact on activities of daily living.  On physical exam the gait was normal.  ROM was flexion 120 degrees; extension reduced 8 degrees without painful motion.  Slight “laxity” of the knee was reported.  Motor, sensory and reflex exams were normal.  At this time the CI was fully employed as a general laborer.

The Board directed attention to its rating recommendation based on the above evidence.  The PEB and the VA both rated the knee condition under, code 5257 (knee impairment/instability), but at different ratings; the PEB rated 20% (moderate) and the VA rated 10% (slight).  Under this code the highest rating, 30%, requires the condition to be “severe.”  The VA adjudicated an additional rating of 10%, code 5262, for reduced extension of the knee on ROM testing.  The Board agreed that this case justifies consideration of separate ratings for instability and painful motion, or for combined ratings for flexion, extension and instability, (if all meet ratable criteria), as established by formal VA policy in effect at the time of separation (General Counsel Opinion of 1 July 1997 and Fast Letter 04-22 of 1 October 2004).  

The Board agreed the record in evidence supported a rating of the knee for ACL instability, under code 5257.  The Board concluded that the condition was “mild,” given findings of only mild laxity/instability on quantative clinical testing.  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 knee condition for instability coded 5257.  The Board agreed that the record in evidence referenced above does not support the knee condition to rise to the level of 10% for painful motion IAW §4.40 and §4.59.  After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the Board recommends no disability rating for the knee condition for painful motion.

The Board considered rating under ROM criteria.  The Board agreed that the record in evidence supported no rating for the knee for limitation of flexion under code 5260.  The Board considered a rating under code 5261 (limitation of extension).  Under this code a rating of 0% requires a loss of extension of 5 degrees.  The next higher rating, 10%, requires a loss of extension of 10 degrees.  The Board noted the reduced active extension of 8 degrees on the C&P exam and the normal extension on an assisted examination on the NARSUM.  The Board gave higher probative value to findings on active examination of the C&P exam.  The Board agreed that the loss of 8 degrees of extension more closely approximated the 10% rating than the 0% rating under this code.  The Board thus recommends a rating of 10% of the knee, coded 5261.

The Board agreed that the record reference above supported no rating higher than 20% (moderate) under code 5262 (tibia/fibula impairment) for the combined knee condition.  The Board found no other codes for consideration or pathway to a rating higher than 20% for the knee condition.  After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the Board recommends a combined rating of 10%, coded 5257 and 10%, coded 5261 IAW §4.71a for the knee condition for a combined rating of 20%.  However, as this provides no rating benefit to the CI, the Board recommends no change in the PEB adjudication for the 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 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 20140204, 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 XXXXXXXXXXXXXXXXXXXX:

Reference your application submitted under the provisions of DoDI 6040.44 (Title 10 U.S.C. § 1554a), PDBR Case Number PD-2014-00717.

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