RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME: XXXXXXXXXXXX						           CASE:  PD-2014-00988
BRANCH OF SERVICE: AIR FORCE	SEPARATION DATE:  20080303

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E-4 (Munitions Systems Journeyman) medically separated for a right knee condition with weakness of the right quadriceps muscle.  The right knee could not be adequately rehabilitated to meet the physical requirements of his Air Force Specialty (AFS).  He was issued a temporary L4 profile and referred for a Medical Evaluation Board (MEB).  “Osteoarthritis and chondromalacia patella of the right knee,” was forwarded to the Physical Evaluation Board (PEB) IAW AFI 48-123.  No other conditions were forwarded by the MEB.  The Informal PEB adjudicated “osteoarthritis and chondromalacia patella, right knee,” and “weakness right quadriceps muscle” as unfitting, rated 10% and 10%, respectively, with application of the Veterans Affairs Schedule for Rating Disabilities (VASRD).  The CI made no appeals and was medically separated. 

CI CONTENTION:  The CI contends for conditions not included in the MEB/PEB process.  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 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 20080110	VA* - ~2 Months Post-Separation	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Osteoarthritis and Chondromalacia Patella, Right Knee	5099-5003	10%	Osteoarthritis, Chondromalacia Patella, Right Knee, S/P Surgical Repairs	5260-5010	10%	20080512	
Weakness, Right Quadriceps Muscle	5314	10%	Right Leg Numbness, Secondary to Quadriceps Repair and
Tibial Tubercle Realignment	5311-8526	20%	20080512	
Other MEB/PEB Conditions x 0 (Not In Scope)	Other x 9	
COMBINED RATING:  20%	COMBINED RATING:  40%	
*Derived from VA Rating Decision (VARD) dated 20081003 (most proximate to date of separation (DOS)).  

ANALYSIS SUMMARY:    

Osteoarthritis and Chondromalacia Patella, Right Knee. According to service treatment records (STR) and the MEB narrative summary (NARSUM), the CI underwent 5 right knee surgeries: benign tumor in February 2004, emergency irrigation and drainage in April 2004, medial and lateral release in March 2005, repair of quadriceps tendon in March 2006, and tibial tubercle realignment in December 2006.  Despite surgery, physical therapy, and pain medications, the CI’s knee condition could not be adequately rehabilitated.  At the NARSUM examination performed 5 months prior to separation, the CI reported chronic right knee swelling, stiffness, and pain.  The physical exam showed trace swelling, tenderness to palpation, crepitus, pain with patellar compression, and normal stability testing.  The VA compensation and pension (C&P) examination performed 2 months after separation, showed an antalgic gait, painful right knee motion, and normal stability testing.  

The Board directed its attention to its rating recommendation based on the above evidence.  The PEB and VA assigned a 10% rating coded 5099-5003 (degenerative arthritis) and 5260-5010 (leg limitation of flexion-arthritic due to trauma), respectively.  There was no limitation of flexion or extension that supported a minimum 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 based on §4.59, §4.40 and §4.45.  The examinations proximate to separation did not demonstrate the presence of ligamentous laxity, instability, or frequent locking with effusions.  Therefore, there was no VASRD §4.71a route to a rating higher than 10% under any other diagnostic codes (5257 or 5258), 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 chronic right knee pain condition was appropriately recommended in this case. 

Weakness, Right Quadriceps Muscle. In December 2006 the CI was diagnosed with a non-traumatic quadriceps tendon rupture and underwent surgical repair.  Postoperatively the CI continued to have right quadriceps weakness.  The NARSUM physical examination showed that the right quadriceps muscle was 1.5cm smaller than the left and 4/5 quadriceps strength.  The CI reported right lateral thigh numbness during the VA C&P examination performed 2 months after separation.  The physical examination showed atrophy of the right quadriceps and 5/5 strength.  

The Board directed its attention to its rating recommendation based on the above evidence.  The PEB assigned a 10% rating, coded 5314 (Group XIV, moderate muscle impairment) citing weakness of the right quadriceps muscle.  VA assigned a 20% rating, coded 5311-8526 (Group XI Muscle injury-anterior crural nerve) citing moderate incomplete paralysis of the thigh muscle.  The examinations proximate to separation did not demonstrate moderately severe muscle impairment for a higher rating under 5311 and 5314.  The Board noted that the primary functional impairment impacting satisfactory duty performance was motor versus sensory and therefore determined that there was no grounds for additional (or higher) rating under code 8526.  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 quadriceps weakness condition was appropriately recommended in this case. 

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 osteoarthritis and chondromalacia right knee condition and IAW VASRD §4.71a, the Board unanimously recommends no change in the PEB adjudication.  In the matter of the right quadriceps weakness 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 20140225, with attachments
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-2014-00988.

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