RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	      CASE:  PD-2015-00595
BRANCH OF SERVICE:  AIR FORCE	 SEPARATION DATE:  20051017

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E5, Security Forces Journeyman medically separated for arthritis of bilateral knees with a disability rating of 20%.

CI CONTENTION:  The CI contends not all conditions were included in the PEB ratings.  The applicant’s complete submission, is at Exhibit A.  

SCOPE OF REVIEW:  The panel’s scope of review is defined in DoDI 6040.44.  It is limited to review of disability ratings assigned 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 or non-compensable.  Any conditions outside the panel’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 panel’s authority is limited to assessing the fairness and accuracy of PEB rating determinations and recommending corrections, where appropriate.  The panel’s assessment of the PEB rating determination is based on 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(s) at the time of separation.  The panel 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 panel 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 - 20050823	No probative VA claim in evidence	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Tricompartmental Osteoarthritis (Bilateral Knees)	5003	20%					
Pseudofolliculitis Barbae	Category III 					
COMBINED RATING:  20%	COMBINED RATING ALL VA CONDITIONS:  NA	

ANALYSIS SUMMARY: 

Bilateral Knee Condition.  The service treatment records (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM) documented a remote history of sports trauma to the knees with arthroscopic surgery (chondroplasty) of the right knee at age 15.  The CI first presented in service in February 2004, complaining of bilateral knee pain with playing basketball.  He was diagnosed by X-ray with moderate degenerative osteoarthritis of both knees.  The pain worsened with time and an orthopedic consultant opined that surgery was not indicated, recommending a series of Synvisc (artificial cartilage substitute) injections.
There was ample STR documentation of the absence of subjective instability or locking, the absence of effusion, and stability to stress testing in all planes.  The CI later complained of “buckling” and “giving out” during MEB proceedings, but this was specifically evaluated and there was no objective instability by physical examination.  There were multiple STR clinical entries that documented grossly normal range of motion (ROM) for each knee, and there were no entries that indicated significantly limited ROM.  Measured ROM by orthopedics was bilateral flexion to 130 degrees (normal 140), and extension to minus 10 degrees (normal 0) on the right and 0 degrees on the left.  A second orthopedist later recorded “full” bilateral flexion with extension to minus 5 degrees on the right and minus 2-3 degrees on the left.  Conservative measures did not result in sufficient improvement to allow unrestricted duty, and the CI was referred for an MEB which in turn forwarded “tricompartmental osteoarthritis bilateral knees” to the PEB.  

The NARSUM examination on 6 July 2005, 4 months before separation, stated, “Currently he has not had any further daily pain (0 out of 10) in the knees, since having the Synvisc injections he does complain of daily stiffness which is worse with bending his knees and squatting, and prolonged sitting for greater than 1 hour, and ruck walking.”  The physical examination recorded the bilateral absence of effusion or tenderness, “full” ROM, 4-plane stability to stress testing, and no mechanical impingement.

The panel directed attention to its rating recommendation(s) based on the above evidence.  The PEB’s bilateral 20% rating under code 5003 (degenerative arthritis) did not specify separate 10% ratings or elaborate a rationale; but, members agreed that it was reasonable to treat the PEB adjudication as separate 10% ratings for each knee (bilateral factor incorporated) and to individually assess each knee for the possibility of a rating higher than 10%.  There was no ROM limitation, persistent effusion and locking, or fracture with non-union or malunion to achieve a rating higher than 10% under any applicable code for either knee and there was no objective evidence of joint instability for separate rating of either knee.  
After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the panel concluded that there was insufficient cause to recommend a change in the PEB adjudication of the bilateral knee condition.

Contended Pseudofolliculitis Barbae.  This condition (facial dermatitis in the beard area) was only mentioned in passing in the NARSUM and was not elaborated, but it was adjudicated as Category III, not separately unfitting, by the PEB.  It was not profiled or implicated in the commander’s performance statement.  The panel’s main charge was to assess the fairness of the PEB’s determination that the condition was not unfitting.  The panel’s threshold for countering fitness determinations requires a preponderance of evidence, but remains adherent to the DoDI 6040.44 “fair and equitable” standard.  Members agreed that there was no performance-based evidence indicating that the condition interfered with duty requirements to an extent that would have prohibited further military service.  

After due deliberation in consideration of the preponderance of the evidence, the panel concluded that there was insufficient cause to recommend a change in the PEB fitness determination for the pseudofolliculitis barbae condition and therefore was not eligible for Service rating.

BOARD FINDINGS:  In the matter of the bilateral knee condition and IAW VASRD §4.71a, the panel unanimously recommends no change in the PEB adjudication.  In the matter of the contended pseudofolliculitis barbae condition, the panel unanimously recommends no change from the PEB determination as Category III.  There were no other conditions within the panel’s scope of review for consideration.  The panel, 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 20150604, with attachments
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

SAF/MRB
1500 West Perimeter Road, Suite 3700
Joint Base Andrews, MD  20762

Dear XXXXXXXXXXXXXXXXXX:

Reference your application submitted under the provisions of DoDI 6040.44 (Section 1554, 10 USC), PDBR Case Number PD-2015-00595.

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,

Director
Air Force Review Boards Agency

Attachment:
Record of Proceedings