RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXXX	CASE:  PD-2014-01340
BRANCH OF SERVICE:  Air Force	SEPARATION DATE:  20090928

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty, E4, Non-destructive Inspection Journeyman, medically separated for “right knee pain, status post correction of anterior cruciate ligament, medial collateral ligament and medial meniscus with recurring episodes of locking” with a disability rating of 20%.

CI CONTENTION:  The applicant makes no specific contention in his application.  The applicant’s complete submission is at Exhibit A.

SCOPE OF REVIEW:  The Board’s scope of review is defined in DoDI 6040.44.  It is limited to those conditions determined by the Physical Evaluation Board (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 - 20090624	VARD - 20100329	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Right Knee Pain…	5258	20%	Right Knee Postoperative Residuals, ACL Tear	5260	10%	20090928	
COMBINED RATING:  20%	COMBINED RATING OF ALL VA CONDITIONS:  20%	

ANALYSIS SUMMARY:

Right Knee Pain.  According to service treatment records and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s right knee condition began in October 2007 when he squatted and felt a sudden pop.  The CI underwent arthroscopic right knee surgery on 14 December 2007 for an anterior cruciate ligament (ACL) reconstruction and partial medial meniscectomy.  At the time of his follow-up on 12 February 2008 he was full weight bearing and range of motion (ROM) was noted as “good.”  At the time of the orthopedic examination on 27 August 2008 the CI reported some popping and medial and lateral pain.  On examination there was a markedly palpable pop and locking sensation with ROM.  Testing for meniscal pathology was positive (Apley’s and McMurray’s).  Magnetic resonance imaging (MRI) was ordered and significant changes of the medial meniscus were noted.  He underwent arthroscopic surgery in October 2008.  At the time of the 7 November 2008 orthopedic examination the CI was noted to be doing better and ROM and strength were improving.  The CI reported the popping or clicking present before surgery was gone.  Despite treatment, 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 MEB.

The MEB NARSUM dated 17 December 2008, 9 months before separation, noted the CI continued to have a burning sensation mostly on the medial aspect of the right knee with some intermittent locking.  Pain was aggravated by prolonged sitting, standing, squatting, cutting movements and running.  The physical examination noted no swelling, limited flexion to approximately 100 degrees (normal 140) with tenderness of the patella and medial joint line.  There was “slight” laxity of the ACL noted, but with “a good endpoint,” and testing for meniscal pathology was negative.  At follow-up orthopedic visits in February and April 2009 the CI reported pain at times with intermittent swelling.  The examinations noted “good overall motion” and “some” crepitus, with the April visit noting “a little bit” of swelling.  The examiner indicated that he thought the symptoms were due to arthritis and the CI was given a steroid injection.  An addendum to the NARSUM dated 6 May 2009 indicated there had been no significant interval change in the CI’s condition.

At the VA Compensation and Pension (C&P) examination on 28 September 2009, performed on the day of separation, the CI reported residual limited ROM with flexion and pain, usually on a daily basis.  The physical examination noted normal posture and gait.  The right knee was mildly enlarged with ROM of flexion 120 degrees and extension of 0 degrees (0 normal).  Testing for meniscal pathology was positive and there was no evidence of significant laxity of the ACL.  

The Board directed its attention to its rating recommendation based on the above evidence.  The PEB assigned a 20% rating under the 5258 code (cartilage, semilunar dislocated with frequent episodes of “locking, pain and effusion into the joint), citing pain and recurring episodes of locking.  The VA assigned a 10% rating using the 5260 code (leg, limitation of flexion) based on the VA C&P examination on the day of separation, citing (painful or limited ROM; no instability and no additional functional impairment with repetitive motion).  There was no evidence of severe subluxation or lateral instability to support a 30% rating under the 5257 code (knee, other impairment).  There was no limitation of flexion or extension that supported a rating under the 5260 or 5261 codes (limitation of flexion/limitation of extension).  Finally, there was no fracture, non-union, or malunion of the femur or tibia to support consideration under the respective codes for knee impairment related to long bone conditions (5255, 5262).  The maximum rating under the 5258 code is 20%.  There is therefore no VASRD §4.71a route to a rating higher than the 20% adjudicated by the PEB.  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 right knee condition.

BOARD FINDINGS:  In the matter of the 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.  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 20140316, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

SAF/MR
1500 West Perimeter Road, Suite 3700
Joint Base Andrews, MD  20762

Dear XXXXXXXXXX:

Reference your application submitted under the provisions of DoDI 6040.44 (Section 1554, 10 USC), PDBR Case Number PD-2014-01340.

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