RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2014-01607
BRANCH OF SERVICE:  AIR FORCE	SEPARATION DATE:  20090526

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E5, Aviation Resource Management Craftsman, medically separated for a chronic right knee pain condition, rated at 10%.

CI CONTENTION:  Her condition continues to worsen and negatively impact her daily activities.  Her 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 - 20090204	VARD - 20100729 	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Right Knee Pain	5003	10%	Right Knee Strain	5257-5010	10%	20100510	
RATING:  10%	RATING:  30%	

ANALYSIS SUMMARY:  

Chronic 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 August 2006 while running during unit physical training.  An MRI done in September 2006, came back normal, and later in November 2006 an MRI showed only tiny joint effusion.  Orthopedic evaluation concluded with a diagnosis of patellofemoral pain syndrome.  She underwent orthopedic surgery on the knee in January 2008 to improve the tracking of the knee cap (lateral retinacular release).  Post-operative orthopedic examination on 22 July 2008 noted there was no instability of the patellofemoral joint.  MRI on 11 September 2008 demonstrated the lateral retinaculum release but was otherwise normal.  Despite treatment, the CI’s knee condition could not be adequately rehabilitated to meet the physical requirements of her military specialty and was referred for an MEB.  

The MEB NARSUM, dated 20 October 2008, 7 months prior to separation, the CI reported she was unable to run, with limited walking/cycling, and her knee felt like it tended to give way at times.  The physical therapy MEB ROM is recorded in the chart above.  At an orthopedic examination on 1 December 2008, the right knee ROM was “full.”  There was tenderness, but there was no instability.  Lower extremity strength was normal.  At the VA Compensation and Pension (C&P) examination on 10 May 2010, 11 months after separation, the CI reported severe constant pain with constant moderate to severe stiffness and weakness.  Physical examination showed no pain or crepitus with motion noted, and tests for ligamentous instability and meniscus pathology were negative.  The ROM was mildly limited in flexion as recorded in the chart above.  

The Board directed attention to its rating recommendation based on the above evidence.  The PEB rated the right knee condition 10% (coded 5003) citing painful motion.  The VA rated the right knee condition 10% (coded 5257-5010), citing painful or limitation of motion, based on the post-separation C&P examination.  There was no limitation of motion which attained a minimum rating under the diagnostic codes for limitation of flexion or extension.  However, there was evidence of painful motion with functional loss supporting a 10% rating (based on §4.59, §4.40 and §4.45) as adjudicated by the PEB and subsequently the VA.  The examinations proximate to separation did not demonstrate the presence of ligamentous instability or laxity (5257), frequent locking with effusions or any indication of dislocated meniscus or loose body (5258), or history of surgery to remove a meniscus (5259) to support a rating under the respective codes.  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).  There is therefore no VASRD §4.71a route to a rating higher than the 10% adjudicated by the PEB under any applicable code, and no grounds for additional rating based on the presence of instability.  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 following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20140401, 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-2014-01607.

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