RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME: XXXXXXXXXXXXXXXXXX	CASE:  PD-2015-00434
BRANCH OF SERVICE:  Air Force 	SEPARATION DATE:  20030520

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty O4 Chaplain, medically separated for “chronic eft knee pain…” with a disability rating of 10%.  

CI CONTENTION:  The CI requested consideration of all 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 - 20030407	VARD - 20040524	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Left Knee Pain	5299-5003	10%	Patellofemoral Syndrome	5257	10%	20040128	
Panic Disorder	Cat II	No VA Placement	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  40%	

ANALYSIS SUMMARY:  

Left Knee Pain.  According to service treatment records (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s left knee pain condition began in 1996 without specific injury or trauma.   Magnetic resonance imaging (MRI) study showed moderate effusion.  The CI underwent two surgical procedures, cortisone and synvisc injections and numerous physical therapy (PT) consults. Following surgery further treatment did not result in improvement sufficient to allow unrestricted duty.  The MEB forwarded “chronic left knee pain…” for PEB adjudication.  

The range of motion (ROM) evaluations in evidence which the Board weighed in arriving at its rating recommendation, with documentation of additional ratable criteria, are summarized in the chart below.  
Left Knee ROM
(Degrees)	MEB ~2 Mos. Pre-Sep
	VA C&P ~8 Mos. Post-Sep
	
Flexion (140 Normal)	125	130	
Extension (0 Normal)	“Has full extension”	5	
Comment	Normal gait 	Tenderness	
§4.71a Rating	10%	10%	

The MEB NARSUM examination on 25 march 2003, 2 months prior to separation, noted complaints of intolerable pain after engaging in physical activity.  The physical examination showed well healed scars of the left knee, full extension, normal gait and a flexion of 125 degrees (normal 140) as noted above.  At the 6 February 2004 VA Compensation and Pension (C&P) evaluation, performed 8 months after separation, the CI reported that on occasion his left knee had given out.  The CI also complained of left knee pain when walking and at rest.  The physical exam showed tenderness and inability to fully extend the knee as noted above.  

The Board directed attention to its rating recommendation based on the above evidence.  The PEB rated the left knee 10%, analogously coded 5299-5003 (degenerative arthritis).  The VA rated the left knee 10% coded 5257 (knee, other impairment of), based on the VA C&P examination 8 months after separation, citing a flexion of 130 degrees and 5 degrees of extension. The examinations proximate to separation 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.  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 chronic left knee pain condition.  

Contended PEB Conditions:  Panic Disorder.  The Board’s main charge is to assess the fairness of the PEB’s determination that the panic disorder condition was not unfitting.  Although the contended condition was profiled, it was not implicated in the commander’s statement or judged to fail retention standards.  There was no performance-based evidence from the record that the condition significantly interfered with satisfactory duty performance at separation.  The psychiatric NARSUM on 11 March 2003, 2 months prior to separation, noted the CI’s panic disorder and social phobia as stable with continued daily use of Paxil.  The CI had no history of suicidality, psychosis, depressive episodes, inpatient hospitalizations or previous psychiatric encounters.  The CI had a Global Assessment of Functioning (GAF) score of 85.  After due deliberation, the Board concluded that there was insufficient cause to recommend a change in the PEB fitness determination for the contended condition and so no additional disability rating is recommended.  

BOARD FINDINGS:  In the matter of the chronic left knee pain condition and IAW VASRD §4.71a, the Board unanimously recommends no change in the PEB adjudication.  In the matter of the contended panic disorder condition, the Board unanimously recommends no change from the PEB determination as not unfitting.  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 20150601, 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-2015-00434.

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