RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW
NAME: XXXXXXXXXXXXXXXXXX	CASE:  PD-2015-00639
BRANCH OF SERVICE:  Air Force 	SEPARATION DATE:  20070725

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an Reserve E6, Crew Chief, medically separated for “left knee pain,” with a disability rating of 10%.  

CI CONTENTION:  “Review 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 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 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 - 20070608	VARD - 20070922	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Left Knee Pain due to Osteoarthritis	5003	10%	Chronic Left Knee Pain	5010-5260	10%	20070828	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  10%	

ANALYSIS SUMMARY:  

Left Knee Pain due to Osteoarthritis:  According to service treatment records and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s left knee condition began in 1999 without specific injury or trauma, although there was a reference to a twisting injury.  In 1999 he underwent a left knee arthroscopy procedure for a degenerative tear of the medial meniscus and a lateral collateral ligament tear.  Thinning cartilage and femoral chondral lesions were also noted.  In April 2005 the CI sustained another twisting injury to his knee, which was treated with physical therapy.  An X-ray in May 2005 showed “almost no joint space left in the lateral compartment.”  In November 2005 the CI had a steroid injection to calm the symptoms of an acute flare of the osteoarthritis of the left knee.  In March 2006 he received at least three Synvisc (a joint lubricant) injections with significant improvement.  An orthopedic review of X-rays in January 2007 noted the left knee had moderate to severe tricompartmental degenerative changes with a slight decrease in lateral joint space, but without bone-on-bone.  Surgical intervention was not recommended, but repeat Synvisc injections were recommended along with not being involved in any high impact activities.  

Despite treatment following the injury in 2005 there was not sufficient improvement to allow unrestricted duty.  The MEB forwarded “degenerative joint disease, left knee” for PEB adjudication.  The MEB NARSUM examination on 15 February 2007, 6 months prior to separation, noted a second torn meniscus in 2005, but surgery was not offered due to advanced arthritis.  The MEB examiner noted obvious deformity but there was no swelling, no induration, no edema and no tenderness to palpation.  The range of motion was full without pain.  At an examination on 2 August 2007, a week post-separation, there was painful motion at the extremes of flexion and extension.  There was no tenderness on palpation of the knee or on ambulation.

At the 28 August 2007 VA Compensation and Pension (C&P) evaluation, performed 1 month after separation, the CI reported  being pain free as long as he did not twist the knee and wore a brace on his left knee.  The CI noted that the brace prevented locking, buckling and flare-ups.  The physical examination revealed a normal gait with a brace in place.  The examiner opined that the CI’s left knee was grossly deformed and enlarged at the medial condyle of the femur and tibia without edema.  There was some ligament laxity and a slightly positive Lachman’s test (to determine laxity); however, there was no pain or crepitus with motion noted.  

The Board directed attention to its rating recommendation based on the above evidence.  The PEB rated the left knee 10%, coded 5003 (arthritis, degenerative).  The VA also rated the left knee condition 10% coded analogously 5010-5260 (arthritis, due to trauma, substantiated by X-ray findings-leg, limitation of flexion), based on the VA C&P examination a month after separation, citing flexion of 90 degrees and a slightly positive Lachman’s test.  There was no limitation of motion which supported a higher rating under the diagnostic codes for limitation of flexion or extension (5260, 5261).  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, 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 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 20150602, 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-2015-00639.

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