RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME: XXXXXXXXXXXXXXXXXX	CASE:  PD-2015-00315
BRANCH OF SERVICE:  Air Force 	SEPARATION DATE:  20080115

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an Air National Guard E3, Basic Trainee, medically separated by the Air Force Board for Correction of Military Records (AFBCMR) for “bilateral knee pain” rated 10% and 10%, respectively, with a combined disability rating of 20%. 

CI CONTENTION:  The CI contends the bilateral knee pain was not properly rated.  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 to be unfitting for continued military service and when specifically requested by the CI, those conditions identified, 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 AFBCMR.  Furthermore, the Board’s authority is limited to assessing the fairness and accuracy of rating determinations and recommending corrections, where appropriate.  The Board’s assessment of the 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:  

BCMR - 20130826	VARD - 20090915	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Left  Knee Pain	5099-5003	10%	Arthritis Of Bilateral Knees	5003	NSC	20090804	
Right Knee Pain	5099-5003	10%					
COMBINED RATING:  20%	COMBINED RATING OF ALL VA CONDITIONS:  0%	

ANALYSIS SUMMARY:  

Bilateral Knee Pain.  According to service treatment record (STR) and the Medical Consultant’s AFBCMR report, the CI’s bilateral knee pain began on 27 February 2004 after falling on her right knee during basic training.  At the time of medical clinic appointment on 01 March 2004, the CI complained of bilateral knee pain and was diagnosed with “bilateral knee strain vs patellofemoral syndrome.” She was placed on limited duty for two days and provided medication.  Although plain radiographic (x-rays) studies of both knees were normal, a bone scan performed on 15 March 2004 revealed “stress changes in both distal femurs, with shin splints.”   

Pursuant to another medical condition that was considered existing prior to service (EPTS), the CI was “sent home” shortly thereafter for a pre-existing umbilical hernia condition and remained in an unknown military status (2004-2008) until her discharge in 2008 for “failure to adapt to military life.”  The CI eventually filed an application to the AFBCMR alleging that she did not receive proper follow-up care and evaluation of her knee injury and, indeed, was reportedly left "in limbo" for approximately 3 years.  The AFBCMR did concede that in regards to the CI’s allegation, both a probable error and injustice occurred.  Ultimately, the AFBCMR found in favor of the CI and recommended that sufficient evidence existed to establish a nexus between the CI’s knee injury of February 27, 2004 and chronic knee pain over the 3 years thereafter.  There were no Medical Evaluation Board (MEB), Physical Evaluation Board (PEB), or Veterans Administration (VA) documents or examinations contained in the case file.  

The PDBR was tasked to determine the appropriateness of the AFBCMR’s final recommendation as stated above.  After an extensive review of the service treatment record (STR), all Board members agreed that very similar complaints of bilateral knee pain with persistent diagnoses indicating the same remained unchanged from the last STR in 2004 and continued in the STR of 2009.  In addition, the knees radiographically went from normal to revealing “mild” osteoarthritis, bilaterally.  There was no documented limitation of motion which would support an impairment rating under the diagnostic codes for limitation of flexion or extension (5260, 5261). The clinical examinations in either 2004 or 2009 did not demonstrate the presence of ligamentous instability or laxity (5257), and there was no history of dislocated meniscus or loose body causing frequent locking with recurrent effusions (5258), 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).  All Board members agreed that the CI’s persistent pain symptoms confined to either knee would preclude her from performing the required duties expected from a basic trainee; and therefore, the AFBCMR’s finding of each knee as separately unfitting was appropriate in this case.  The 2009 X-ray finding of developed bilateral osteoarthritis only strengthened the fact of her condition severity in the earlier years.  

The Board then considered the proper rating for the CI’s bilateral knee condition and concluded that absent other physical examination parameters as mentioned above, 10% for each knee, and no higher, were appropriately recommended by the AFBCMR.  After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the Board concluded that the AFBCMR’s recommendation, as based upon clear and unmistakable evidence, was appropriate in a combined impairment rating of 20% (10% each knee).    

BOARD FINDINGS:  In the matter of the bilateral knee pain condition and IAW VASRD §4.71a, the Board unanimously recommends no change from the AFBCMR’s recommendation.  There were no other conditions within the Board’s scope of review for consideration.  The Board, therefore, recommends that there be no modification or re-characterization of the CI’s disability and separation determination as determined by the AFBCMR.

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20150519, with attachments
Exhibit B.  Service 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-2015-00315.

After careful consideration of your application and treatment records, the Physical Disability Board of Review determined that the rating assigned by the Air Force Board for Correction of Military Records 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