RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXX						            CASE:  PD-2014-00807
BRANCH OF SERVICE:  AIR FORCE	 SEPARATION DATE:  20070716

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E-4 (Desk Sergeant) medically separated for a left knee condition.  The left knee condition could not be adequately rehabilitated to meet the physical requirements of his Air Force Specialty (AFS).  He was issued an L4 profile and referred for a Medical Evaluation Board (MEB).  “Chronic left knee pain” was forwarded to the Physical Evaluation Board (PEB) IAW AFI 48-123.  No other condition was submitted by the MEB.  The Informal PEB adjudicated “left knee pain status post-surgical repair of torn meniscus” 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:  The CI believes his rating was too low and should have been evaluated for his right knee, hip, and right ankle as a secondary conditions caused by favoring his left knee.

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 20070523	VA* - (~8 Mos. Post-Separation)  	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Left Knee Pain S/P Surgical Repair of Torn Meniscus 	5260	10%	Internal Derangement, Left Knee	5260-5010	10%	20080322	
Other MEB/PEB Conditions x 0 (Not In Scope)	Other x 11 	
RATING:  10%	COMBINED RATING:  20%	
*Derived from VA Rating Decision (VARD) dated 20090326 (most proximate to date of separation (DOS)).  

ANALYSIS SUMMARY:  

Left Knee Pain Status Post-Surgical Repair of Torn Meniscus Condition.  The record shows that the CI was evaluated for a month long history of left knee pain on 20 October 2005.  He had a prior history of left knee pain almost 10 years earlier associated with jumping off of a piece of equipment while in the US Army.  He was thought to have a Bakers Cyst (a benign swelling of a bursa [fluid filled sac] behind the knee) and was referred to orthopedics.  There, he was noted to have signs of instability in the anterior direction, but no signs of meniscal (a cartilage cushion in the knee) damage or instability to the sides or posteriorly.  However, on MRI, a tear in the medial (inside) meniscus was seen for which he was treated surgically on 1 February 2006.  The operative report is not in evidence.  Despite rehabilitation following surgery, he had persistent pain.  A series of injections with hyaluronic acid (a fluid to lubricate the joint) provided partial relief, but he was still not able to meet full duty requirements.  On 18 October 2006, in physical therapy (PT), he was noted to have instability to the sides, and painful flexion limited to 108 degrees.  One month later in PT, flexion was 110 degrees.  In primary care on 28 December 2006, flexion was now limited to 80 degrees.  At an orthopedic follow-up on 2 February 2007, a year after surgery and 5 months prior to separation, he was noted to have some medial (to the inside) instability, but anterior and posterior instability was now absent.  No comment was made on motion or the menisci.  Swelling was absent.  The narrative summary (NARSUM) was dated 22 March 2007, but the examination mirrored one done in primary care on 8 February 2007.  The CI reported the inability to run, stand for prolonged periods, or kneel.  The gait was normal.  Flexion was reduced at 45 degrees and extension was limited to 5 degrees.  Pain was present at the extremes of motion.  The joint was stable (no laxity).  Provocative testing for meniscal irritation was not recorded, but joint line tenderness was present.  At the VA Compensation and Pension (C&P) examination performed on 26 March 2008, 8 months after separation, the CI reported no periods of incapacitation in the prior 12 months.  He was not limited in the activities of daily living or in his recreation.  His gait was noted to be abnormal as he was compensating for his knee.  Flexion was limited to 110 degrees with full extension.  No comment was made on stability or the menisci.  A subsequent VA C&P examination was accomplished on 14 April 2011.  He was noted to have a normal gait.  Other than the meniscal repair prior to separation, the CI noted no surgery of the left knee.  Instability was absent on this examination, implying that his knee was stable at separation as well.  Flexion was limited to 128 degrees.  The goniometric range-of-motion (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.

Left Knee ROM
(Degrees)	PT ~8 Mo. Pre-Sep	MEB ~4 Mo. Pre-Sep	VA C&P ~5 Mo. Post-Sep	
Flexion (140 Normal)	110	45	110	
Extension (0 Normal)	---	5	0	
Comment	“SX AT EROM”	Pain at extremes; normal gait and stance.	Abnormal gait; painful motion	
§4.71a Rating	10%	10%	10%	

The Board directed its attention to its rating recommendation based on the above evidence.  The PEB and VA both rated the knee at 10%, coded 5260 (limitation in flexion).  The VA also used the code 5010 (traumatic arthritis).  The NARSUM recorded flexion at 45 degrees, supporting a 10% rating.  The limitation in motion was otherwise non-compensable; the painful motion did support a 10% rating IAW VASRD §4.59 (painful motion).  Instability was not documented proximate to separation.  The Board found no route to a rating higher that the 10% adjudicated by the PEB.  The Board noted that the VA upheld the 10% rating for the left knee on review as documented in the 21 May 2011 VA rating decision.  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 left 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 left 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 re-characterization of the CI’s disability and separation determination.  

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20140131 w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

SAF/MRB

Dear XXXXXXXXXXXX:

Reference your application submitted under the provisions of DoDI 6040.44 (Section 1554, 10 USC), PDBR Case Number PD-2014-00807.

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