RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME: XXXXXXXXXXXXXXXXXX	CASE:  PD-2015-00306
BRANCH OF SERVICE:  Air Force	SEPARATION DATE:  20021202

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E5, Aircraft Maintenance F-16/F-117 Craftsman, medically separated for “chronic left knee pain” with a disability rating of 20%.

CI CONTENTION:  The CI contends his left knee condition was rated 30% by the VA to include instability which was present during the time of the MEB.  He also contends right Achilles tendon and left shoulder conditions.  The CI’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 based upon a 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 - 20020930	VARD - 20021219	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Left Knee Pain	5257	20%	Status Post Left Knee ACL Repair	5260	10%	20021108	
COMBINED RATING:  20%	COMBINED RATING OF ALL VA CONDITIONS:  20%	

ANALYSIS SUMMARY:  

Left Knee.  According to service treatment records and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI underwent ACL reconstructions in 1993 and 1996.  He reinjured his knee in December 2000 after slipping on ice.  Magnetic resonance imaging showed partial tearing of the ACL graft, a medial meniscus tear and arthritis.  The CI underwent surgery for repair of the meniscal tear in January 2002, with debridement of scar tissue and chondromalacia.  Despite treatment, the left knee condition could not be adequately treated to meet the physical requirements of the CI’s military specialty and the CI was referred for MEB.  The MEB forwarded “left knee pain” for PEB adjudication.

The MEB NARSUM examination on 20 August 2002, 4 months prior to separation, noted complaints of left knee pain exacerbated by deep squatting and carrying heavy loads.  Physical examination showed minimal effusion, significant palpable crepitus and patella tenderness.  There was full range of motion (ROM).  Painful motion and instability were not cited.  Left knee X-rays showed post-surgical changes with hardware in place and degenerative joint disease.

At the 08 November 2002 VA Compensation and Pension (C&P) evaluation, 1 month before separation, the physical examination revealed a normal gait.  The knee showed no subluxation (knee cap not popping out of position), locking, or joint effusion and instability testing was negative.  Knee ROM was flexion 140 (normal) and extension 0 (normal) with crepitus.  Painful motion was not cited.

The Board directed attention to its rating recommendation based on the above evidence.  The PEB rated the left knee condition 20%, coded 5257 (knee, other impairment), citing status post two anterior cruciate ligament surgeries.  The VA rated the left condition 10% coded 5260 (leg, limitation of flexion) based on the VA C&P examination less than 1 month before separation, citing slight crepitus.  The PEB assigned a 20% rating, under the 5257 code for moderate knee impairment.  The Board agreed that the CI’s knee impairment could not be characterized as severe for a higher rating under 5257, based upon the normal gait noted at the pre-separation VA examination.  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 no ankyloses of the knee (5256) 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 was also no evidence of knee instability for consideration of dual rating of the knee.  There was, therefore, no path to a higher evaluation with any applicable VASRD code.  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.  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 20150512, 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-2015-00306.

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