RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2015-00903
BRANCH OF SERVICE:  Air Force 	SEPARATION DATE:  20050118

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E3, Precision Measurement Equipment Lab Apprentice, 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 - 20041108	VARD – NA	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Left Knee Pain Status Post Medical Meniscal Repair	5257	10%	No VA Examination in Evidence	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  NA	

ANALYSIS SUMMARY:  

Left Knee Pain Status Post Medical Meniscal Repair.  According to service treatment records (STRs) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s condition began in February 2003 while running.  Despite a prolonged course of physical therapy, he complained of left knee pain, swelling and occasional locking.  Magnetic resonance imaging (MRI) dated 7 September 2003 demonstrated minimal to mild lateral subluxation of the patella (knee cap) with a prominent type II change involving the posterior horn of the medial meniscus, which did not clearly communicate with an articular surface (no clear evidence of a meniscal tear).  On 9 March 2004 the CI underwent left knee diagnostic arthroscopy with a medial meniscus tear repair.  Postoperatively he had continued pain in the left knee with complaints of popping and “locking up” with stiffness, which was not responsive to Voltaren (diclofenac, a nonsteroidal anti-inflammatory drug (NSAID).  At a 17 June 2004 orthopedic examination the CI’s range of motion (ROM) measurements were flexion of 145 degrees (140 normal) and extension of -5 degrees (0 normal).  There was no instability (negative Lachman, negative anterior/posterior drawer tests and stable varus and valgus) and a negative McMurray test (to determine a meniscal tear).  There was tenderness at the inferior pole of the patella and proximal patellar tendon.  The CI then underwent therapy for patellar tendonitis.  At a follow-up orthopedic visit on 13 August 2004, the CI continued to report popping and catching and occasionally needed to twist his leg to “unlock” the knee.  He also noted occasional swelling and pain when he attempted to bike or use an elliptical trainer.  On examination the ROM was unchanged and there was again no laxity, but there was tenderness on the medial joint line and a positive McMurray’s test.   The examiner’s impression was a failed medical meniscus repair and he referred the CI for a follow-up arthroscopy.  

Following surgery further treatment did not result in improvement sufficient to allow unrestricted duty.  The MEB forwarded “left recurrent medial meniscus tear status post left medial meniscal repair” for PEB adjudication.

At the 27 August 2004 MEB NARSUM examination, 5 months prior to separation, the CI reported 8/10 (10 being the worst) left knee pain, which was exacerbated with walking, bending, and weather changes.  He also noted continued popping and occasional catching.   On examination the ROM was 0-120 degrees with a normal extension.  The knee had no laxity and a negative pivot shift test; however, the CI had slight tenderness on the medial joint line and a positive McMurray’s test.  The examiner noted that the most recent X-ray studies were normal with no fracture, dislocation, degenerative changes or osteophyte formation.  The final diagnosis was left recurrent medial meniscus tear status post left medial meniscal repair.  Recommendations included a repeat medial meniscal repair versus debridement or continued nonsurgical management.  The CI indicated that he did not wish to proceed with any further surgical intervention and elected to proceed with nonsurgical management. 

The CI did not apply for a VA Compensation and Pension evaluation.

The 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/RIght Knee ROM
(Degrees)	Ortho ~7 Mos. Post-Sep
	Ortho ~5 Mos. Pre-Sep
	MEB ~5 Mos. Pre-Sep
	
Flexion (140 Normal)	145	145	120	
Extension (0 Normal)	-5	-5	0	
Comment	Popping and “locking up” pain; negative McMurray	Popping and catching, pain; positive McMurray; tenderness	No laxity; negative for Instability; positive McMurray	
§4.71a Rating	10%	10%	PEB 10%	
 
The Board directed attention to its rating recommendation based on the above evidence.  The PEB assigned a 10% rating for the left knee condition using code 5257 (knee, other impairment of:  recurrent subluxation or lateral instability; slight).  However, Board members did not note instability in the STRs, but did note the CI underwent a medial meniscus repair that failed which raised the possible use of code 5259 (cartilage, semilunar, removal of symptomatic) at a 10% rating, but which offered no benefit to the CI.  However, the CI did have a positive McMurray’s test postoperatively along with locking, pain, and occasional swelling.  Therefore, the use of code 5258 (cartilage, semilunar, dislocated, with frequent episodes of locking, pain, and effusion into the joint) at 20% is reasonable.  There was no limitation of motion which supported a 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).   Therefore, there was no VASRD §4.71a route to a rating higher than 20%.  After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the Board recommends a disability rating of 20% for the left knee condition, coded 5258.  

BOARD FINDINGS:  In the matter of the left knee condition, the Board unanimously recommends a disability rating of 20%, coded 5258 IAW VASRD §4.71a.  There were no other conditions within the Board’s scope of review for consideration.  

The Board 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 Pain Status Post Medical Meniscal Repair	5258	20%	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20150602, w/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-2015-00903.

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,