RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXXXX	CASE:  PD-2015-00683
BRANCH OF SERVICE:  Air Force 	SEPARATION DATE:  20080812

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E3, Trainee, medically separated for “left knee pain,” with a disability rating of 10%.

CI CONTENTION:  The CI’s conditions continue to worsen and negatively affect daily activities.  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 – 20080620	VARD – CI declined consent to access VA records	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Left Knee Pain w/Patellofemoral Syndrome and Hamstring Tightness	5252	10%					
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  NA	

ANALYSIS SUMMARY:  

Left Knee Pain.  According to service treatment records (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI twisted his left knee while running in October 2007.  A 19 October 2007 left knee X-ray showed a small suprapatellar joint effusion (fluid collection) with no fracture or acute osseous (bony) abnormality.  A 24 October 2007 left knee magnetic resonance imaging (MRI) study showed a possible mild impact injury of the medial femoral condyle with no evidence of fracture, ligament tear, or meniscal tear.  In a 28 March 2008 orthopedic surgery encounter, the CI complained of left anterior infrapatellar knee pain.  He denied new trauma, locking, popping, clicking, or mechanical symptoms.  

The CI reported no significant improvement from physical therapy (PT) with stretching and range of motion (ROM) exercises.  The left knee examination revealed no skin changes, redness, swelling, ecchymosis (bruising), or effusion.  Left knee ROM was flexion of 10 degrees (140 normal) and extension of 0 degrees (normal), with pain in the extremes of extension.  The valgus/varus stress, anterior/posterior drawer and posterior cruciate ligament tests, as well as Lachman and McMurray tests were negative.  The assessment listed left patellofemoral syndrome with excessive hamstring tightness.  The 4 April 2008 NARSUM, 4 months before separation, recounted the history and interventions.  The CI complained of left knee pain which had not resolved after months of PT.  The left knee examination revealed warm and dry skin with no edema, erythema or ecchymosis.  Left knee ROM was flexion of 10 degrees (140 normal) and extension of 0 (normal) degrees with pain in the extremes of extension.  The valgus/varus stress, anterior/posterior drawer, Lachman, pivot shift, and McMurray tests were negative.  The examiner recounted the findings of the X-rays.  The diagnosis listed knee pain secondary to chronic patella subluxation (incomplete/partial dislocation).  On 17 June 2008, 2 months before separation, PT measured 3 repetitions of pain-limited left knee ROM with a goniometer.  Left knee active ROM was flexion of 40/35/50 (140 normal) and extension of 0/0/0 (normal) degrees.  

The Board directed attention to its rating recommendation based on the above evidence.  The PEB assigned a 10% rating under the 5252 code (thigh, limitation of flexion of) citing left knee pain with patellofemoral syndrome, hamstring tightness, and status-post patellar subluxation.  The CI did not give consent to obtain VA records.  There was no knee ankylosis (5256), knee recurrent subluxation/lateral instability (5257), dislocated meniscus (5258), symptomatic removed meniscus (5259), tibia and fibula nonunion/malunion (5262), or genu recurvatum (5263) for consideration under the respective codes.  The ROM values in the proximate examinations did not support a minimum rating under the limitation of knee extension (5261) code.  The ROM values in the NARSUM examination, 4 months before separation, were consistent with the 30% rating (flexion limited to 15 degrees) under the limitation of knee flexion (5260) code.  The 20% rating would require flexion limited to 30 degrees.  The ROM values in the PT examinations, 2 months before separation, were consistent with the 10% rating (flexion limited to 45 degrees).  The Board assigned more probative value to the PT examination because it measured the ROM by 3 repetitions with a goniometer versus the NARSUM examination single ROM values without a goniometer.  Recognizing the temporal relationships to the date of separation, the Board assigned more probative value to the PT examination after therapy and convalescence, as accurately reflecting the CI’s condition on which to base the permanent rating recommendation.  The Board agreed a 10% rating was supported based on VASRD §4.40 (functional loss) or §4.59 (painful motion).  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 20150604, with attachments
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 XXXXXXXXXXXXXXXXXXXXX:

Reference your application submitted under the provisions of DoDI 6040.44 (Section 1554, 10 USC), PDBR Case Number PD-2015-00683.

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