RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXX						            CASE:  PD-2014-00863	
BRANCH OF SERVICE:  AIR FORCE  	 SEPARATION DATE:  20080512		

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E-5 (Traffic Management Craftsman) medically separated for chronic knee pain rated at 10%.  

CI CONTENTION:  The CI requests all condition be considered.  Her 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 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 20080401	VA - (2.4 Mos Post-Separation)	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Knee Pain Secondary to Patellofemoral Syndrome…	5099-5003	10%	Residuals, Post-Operative Internal Derangement, Right
Knee…	5260	10%	20080724	
			Residuals, Left Knee Meniscus Tear, Status Post-Operative	5260	10%	20080724	
Asthma	Cat II	Asthma	6602	10%	20080724	
Other x 0 (Not in Scope)	Other x 10	
Combined:  10%	Combined:  40%	
Derived from VA Rating Decision (VARD) dated 20081205 (most proximate to date of separation [DOS]).   

ANALYSIS SUMMARY:  

Chronic Knee Pain Condition.  

According to service treatment records and the MEB narrative summary (NARSUM), the CI underwent two right knee surgeries in March 2004 and November 2005 for removal of a flap tear to the articular surface of the lateral tibial plateau and meniscal derangement.  Despite postoperative physical therapy, activity modification, and anti-inflammatory the right knee pain persisted.  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.

Knee ROM
(Degrees)	PT ~6 Mo. Pre-Sep
(20071108) 	MEB ~4 Mo. Pre-Sep
(20080125) 	VA C&P ~2 Mo. Post-Sep
(20080724) 	
	Left	Right	Left	Right	Left	Right	
Flexion (140 Normal)	-	132	Normal	FROM	130	120	
Extension (0 Normal)	-	-10	Normal	FROM	0	0	
Comment	-	Normal gait	-	-	-	-	
§4.71a Rating	-	10%	-	10%	-	10%	

The narrative summary (NARSUM) noted tenderness to palpation and pain with motion.  There was no laxity and meniscal signs were absent.  There was no crepitus and examination tests for ligamentous instability and meniscus pathology were negative.  At the VA Compensation and Pension (C&P) examination dated 24 July 2008 (2.4 months after separation), the CI reported constant, severe, sharp right knee pain.  The right knee examination showed mild crepitation, medial tenderness to palpation, and painful motion.  Tests for ligamentous instability and meniscus pathology were negative.

The Board directed attention to its rating recommendation based on the above evidence.  The PEB rated the right knee pain condition at 10%, coded 5099-5003 (analogous to degenerative arthritis).  VA rated the condition at 10%, coded 5260 (leg limitation of flexion), citing painful limited motion of a major joint.  There was no limitation of flexion or extension that supported a higher than 10% rating under the VASRD diagnostic codes for limitation of motion (5260 or 5261).  There was evidence of painful motion with functional loss supporting the 10% rating.  The examinations proximate to separation did not demonstrate the presence of ligamentous laxity, instability, or frequent locking with effusions (or any indication of dislocated meniscus or loose body); therefore, there was no VASRD §4.71a route to a rating higher than 10% and no grounds for additional rating based on instability.  Considering the totality of the evidence and mindful of VASRD §4.3 (reasonable doubt), members agreed that a disability rating of 10% for the right knee pain condition was appropriately recommended in this case.

Contended PEB Conditions.  The Board’s main charge is to assess the fairness of the PEB’s determination that asthma was a Category II condition (can be unfitting, but not compensable or ratable).  The Board’s threshold for countering Category II determinations is higher than the VASRD §4.3 (reasonable doubt) standard used for its rating recommendations, but remains adherent to the DoDI 6040.44 “fair and equitable” standard.  The asthma condition was profiled. The asthma condition was not implicated in the commander’s statement and was noted as well-controlled by the PEB.  All were reviewed by the action officer and considered by the Board.  There was no performance based evidence from the record that the asthma condition significantly interfered with satisfactory duty performance.  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 fitness determination for the contended  asthma condition and so no additional disability rating is recommended. 

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 pain condition and IAW VASRD §4.71a, the Board unanimously recommends no change in the PEB adjudication.  In the matter of the contended Asthma condition, the Board unanimously recommends no change from the PEB determination as Category II.  There were no other conditions within the Board’s scope of review for consideration. 

The Board, therefore, recommends that there be no recharacterization of the CI’s disability and separation determination. 

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20141021, 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 XXXXXXXXXXXX:

Reference your application submitted under the provisions of DoDI 6040.44 (Section 1554, 10 USC), PDBR Case Number PD-2014-00863.

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