RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXX	 CASE:  PD-2014-01170
BRANCH OF SERVICE:  Air Force 	SEPARATION DATE:  20090727

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E4 (HVAC Journeyman) medically separated by the Informal Physical Evaluation Board for “left knee tendonitis” with a disability rating of 10%.

CI CONTENTION:  His condition continues to worsen and negatively impact his daily activities.  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 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 PEB - 20090420	VARD - 20091008	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Left Knee Patellar Tendonitis	5099-5003	10%	Osteoarthritis S/P Left Knee Arthroscopy	5010-5260	10%	20090814	
RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  40%	

ANALYSIS SUMMARY:  

Left Knee Patellar Tendonitis:  According to the service treatment records and the MEB narrative summary (NARSUM), the CI underwent an arthroscopy for a torn meniscus on 26 September 2007.  A radiograph (X-ray) done in January 2009 showed an effusion (fluid accumulation) in the supra patella (above the patella) area.  Despite treatment which included an intra-articular injection, and a knee sleeve to prevent lateral tracking of the patella, the CI’s knee condition could not be adequately rehabilitated to meet the physical requirements of the CI’s military specialty and was referred for a Medical Evaluation Board (MEB).  

At the MEB examination on 4 February 2009, approximately 6 months prior to separation, the CI reported continued parapatellar anterior medial and anterior lateral knee pain with associated clicking and popping which were aggravated by climbing ladders, kneeling, squatting and descending stairs.  The CI denied any instability or swelling.  The exam findings are summarized in the chart below.  

At the VA Compensation and Pension (C&P) examination on 21 August 2009, performed approximately 1 month after separation, the CI reported pain, weakness, swelling, giving way, lack of endurance, locking pain and fatigue.  On physical examination walking was unsteady with a limp and a left knee brace.  Radiographs documented osteoarthritis.  The exam findings are summarized in the chart below.    

The 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)	MEB ~6 Mo. Pre-Sep	VA C&P ~1 Mo. Post-Sep	
Flexion (140 Normal)	115	100	
Extension (0 Normal)	0	0	
Comment	Diffuse tenderness to palpation, pain on patellofemoral compression, palpable clicking patellofemoral joint; 1+ patella mobility varus/valgus stress 1+ opening (symmetric to opposite knee) 	painful motion; weakness, tenderness; guarding of movement; locking pain; no instability, laxity or subluxation; additional limitation of 15 degrees after repetitive use-pain, fatigue, weakness	
§4.71a Rating	10%	10%	

The Board directed its attention to its rating recommendation based on the above evidence.  The PEB assigned a 10% rating under the analogous 5003 code (degenerative arthritis).  The VA also assigned a 10% rating using the analogous code 5010 (arthritis, due to trauma, substantiated by X-ray findings) with 5260 (limitation of flexion), citing decreased leg flexion with arthritic pain.  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 (or any indication of dislocated meniscus or loose body).  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.  Alternative coding analogous to code 5259 (symptomatic semilunar cartilage removal) includes painful motion and would offer no benefit to the CI.  

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:  In the matter of the left knee condition and IAW VASRD §4.71a, the Board unanimously recommends no change in the PEB adjudication.  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 20140226, 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-2014-01170.

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