RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	      CASE:  PD-2014-02825	
BRANCH OF SERVICE:  AIR FORCE	 SEPARATION DATE:  20050204

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty, E5, Aircraft Armament Systems Specialist, medically separated for “chronic right knee pain associated with chondromalacia and medial meniscus tear status post arthroscopy x2” with a disability rating of  10%.  

CI CONTENTION:  The CI requested that the Board review all of his conditions.  The 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 - 20041108	VARD - 20060404  	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Right Knee Pain	5003-5099	10%	Chronic Right Knee Strain	5260	10%	20051017	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  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 April 2002 after a fall while pulling a gun system out of an aircraft.  

The CI underwent three right knee arthroscopic surgeries in August 2002, February 2003 and May 2004 all for medial meniscus repairs.  At the final arthroscopy, chondromalacia was also noted.  Despite treatment, the CI’s knee condition could not be adequately rehabilitated to meet the physical requirements of his military specialty and he was referred for an MEB.  

At an orthopedic follow-up visit on 26 July 2004, 6 months prior to separation and 1 month after the final surgery, the CI reported moderate pain and improvement in the pain and knee popping since his last surgery.  He was unable to run and his walking was limited to 15 minutes.  The examination noted tenderness and a positive patellofemoral grind test.  There was no effusion nor evidence of ligamentous instability or meniscal pathology.  Knee range of motion (ROM) was normal.  

At the MEB NARSUM on 6 October 2005, the CI continued to complain of medial knee pain.  He was able to walk for 15 minutes before needing to rest his knee.  He could not run or jump and had difficulty with squats, kneeling and stairs.  The examination noted full knee ROM, but pain with full extension.  There was moderate medial joint line tenderness, no effusion and all ligaments were intact.  The MEB NARSUM examiner’s assessment was medial meniscal tear and chondromalacia.

At the VA Compensation and Pension (C&P) general examination on 17 October 2005, performed 8 months after separation, the CI reported constant pain in his right knee with a pain level of 8/10, that he could not extend his knee fully, and that he kept his knee bent to control the pain.  He used a cane most of the time.  He also reported weakness, stiffness, swelling, heat, instability, fatigue and lack of endurance.  He further reported that he had occasional locking of his right knee and he heard an audible popping when extending the knee.  He was not able to run, jog or perform any high impact activities.  The CI reported that an initial VA orthopedic evaluation did not recommend additional knee surgery, but he was scheduled for an evaluation for surgery at another medical facility.  The examination noted a limping gait.  There was increased tenderness throughout the right knee joint particularly in the medial aspect of the knee but without any bulges, swelling or effusion.  All knee ligaments were intact without laxity.  The CI had trouble extending his knee fully and kept his knee at minus 10 degrees extension and flexion was 120 degrees, with pain and grimacing, and there was a 10 degree loss of flexion after repetition primarily due to pain.  Muscle atrophy of the right quadriceps muscle was noted.  X-rays taken on 24 June 2005 were reviewed and were normal.  

At a VA orthopedic clinic evaluation on 30 November 2005, 11 months post-separation, the CI reported his right knee recently locked up and he fell.  The examination noted no instability or swelling.  There was diffuse pain and ROM was extension 0 degrees and flexion 110 degrees.  Weight-bearing lower extremity X-rays showed prominence of the right tibia compared with the left.  The orthopedic physician’s assistant noted the X-ray findings did not match up with the CI’s diffuse pain and advised the CI that he may not be a surgical candidate, but the CI requested to see the surgeon.  Later VA notes indicated the CI underwent right knee arthroscopic surgery with lysis of adhesions and cartilage “clean up” in February 2006, 13 months after separation.  The original VA rating decision dated 27 March 2006, noted records from the medical treatment facility following the February 2006 surgery indicated the CI had had no complications and was doing well with moderate pain.  Knee ROM was extension 5 degrees and flexion 105 degrees.

The Board directed attention to its rating recommendation based on the above evidence.  The PEB rated the right knee condition, 10%, coded 5099-5003 (degenerative arthritis).  The VA rated the right knee condition 10%, coded 5260 (limitation of leg flexion) citing pain and limitation of motion, following the surgery in February 2006.  The Board agreed that the evidence supports a 10% rating coded 5259 for symptomatic semilunar cartilage, status post removal, or coded 5099-5003 for limited motion of a single major joint with evidence of degenerative changes, or 5299-5260 or 5299-5261 (analogous to limited leg flexion or extension) for painful motion with functional loss (based on §4.59, §4.40 and §4.45).
There was no limitation of flexion which attained a minimum rating under the diagnostic codes for limitation of flexion or extension (5260).  There was extension limited by 10 degrees noted at the C&P examination, which supports a 10% rating coded as 5261, but no higher.  The examinations proximate to separation did not demonstrate the presence of ligamentous instability or laxity (5257) or frequent locking with effusions (5258), to support a rating under the respective codes and 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 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 20140613, 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-2014-02825.

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