RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2015-00771
BRANCH OF SERVICE:  Air Force	SEPARATION DATE:  20051107

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E3, Supply Management, medically separated for “left knee lateral patellar subluxation status post patellar release and tibial tubercle osteotomy,” rated 20%. The condition was determined to have existed prior to service (EPTS) and a deduction of 10% was taken for a final disability rating of 10%. 

CI CONTENTION:  “Review all Conditions.”  The 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 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 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 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 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 - 20050824	VARD - 20080519	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Left Knee Lateral Patellar Subluxation status post Patellar Release and Tibial Tubercle Osteotomy	5257	20%-10% (EPTS)=10%	Residuals, Post-Operative Tibial Tubercle Osteotomy, Left Knee	5299-5260	0%	STR	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  0%	

ANALYSIS SUMMARY:

Left Knee Lateral Patellar Subluxation Status Post Patellar Release and Tibial Tubercle Osteotomy.  According to service treatment records (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s left knee condition began in October 2003 after climbing down a ladder.  The CI underwent left knee surgery (lateral release and tibial tubercle osteotomy) in March 2004 for patellofemoral malalignment and chondromalacia of the patella, with hardware removal surgery in March 2005.  

During the 8 June 2005 MEB physical evaluation the CI reported chronic knee pain and was considered to have failed surgical correction.  The CI reported that her left knee subluxed with any impact activity and even light activity.  The left knee had full range of motion (ROM) with crepitus.  The MEB NARSUM examination signed on 10 August 2005, 3 months prior to separation, noted complaints of persistent left knee patellar subluxation and pain  inability to run or do impact activities.  Physical examination showed a well healed surgical scar with a non-tender 3 cm tibial tuberosity boney mass.  There was an internal shift of the knee cap with minimal traction and full flexion and extension ROM.  Gait was normal and lower extremity strength, reflexes and sensation were normal.  The 26 August 2002 service entry examination showed no knee or lower extremity symptoms and a normal lower extremity examination.  The CI failed to show for her VA Compensation and Pension evaluation.

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the left knee condition 20%, coded 5257 (knee, other impairment), with an EPTS deduction of 10%, for a final 10% rating, citing that the degree of service aggravation was considered to be no more than 50% of the CI’s current disability.  The VA rated the left knee condition 0%, analogously coded 5299-5260 (leg, limitation of flexion), based on the STR.

The panel adjudged that the CI’s left knee rating on service entry would be undeterminable or 0%, and therefore there was no VASRD basis for an EPTS rating deduction.  The initial PEB rating of 20% for moderate knee impairment was considered reasonable.  There was insufficient objective evidence of painful motion or meniscal or long bone disability for any dual rating of the knee.  There was therefore no VASRD §4.71a route to a rating higher than the initial 20% adjudicated by the PEB under any applicable code.  After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the panel recommends a disability rating of 20% for the left knee condition, coded 5299-5276.

PANEL FINDINGS:  In the matter of the left knee condition, the panel unanimously recommends a disability rating of 20%, coded 5299-5257 IAW VASRD §4.71a.  There were no other conditions within the panel’s scope of review for consideration.  The panel recommends that the CI’s prior determination be modified as follows, effective as of the date of the prior medical separation:

CONDITION	VASRD CODE	PERMANENT RATING	
Left Knee Lateral Patellar Subluxation Status Post Patellar Release and Tibial Tubercle Osteotomy	5299-5257	20%	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20150603, w/atchs
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-2015-00771.

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 not appropriate under the guidelines of the Veterans Affairs Schedule for Rating Disabilities.  Accordingly, the Board recommended modification of your assigned disability rating without re-characterization of your separation with severance pay. 

I have carefully reviewed the evidence of record and the recommendation of the Board.  I concur with that finding, accept their recommendation and direct that your records be corrected as set forth in the attached copy of a Memorandum for the Chief of Staff, United States Air Force.  The office responsible for making the correction will inform you when your records have been changed.

							Sincerely,

XXXXXXXXXXXXXXXXXX
Director
Air Force Review Boards Agency

Attachments:
1. Directive
2. Record of Proceedings

cc:
SAF/MRBR