RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXXXX	CASE:  PD-2015-00913
BRANCH OF SERVICE:  Air Force 	SEPARATION DATE:  20060515

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E1, Security Forces Helper, medically separated for “left knee pain with normal imaging,”  with a disability rating of 0%.  

CI CONTENTION:  The CI requested a review of 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 FPEB - 20060217	VARD - 20150423	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Left Knee Pain 	5099-5003	0%	Left Knee Instability	5257	10%	20150327	
			Left Patellofemoral Pain Syndrome	5260	10%	20150327	
COMBINED RATING:  0%	COMBINED RATING OF ALL VA CONDITIONS:  20%	

ANALYSIS SUMMARY:     

Left Knee Pain.  There was a paucity of source clinical notes in the available service treatment record (STR) for this case, and the Board’s recommendation was derived primarily from the Medical Evaluation Board (MEB) narrative summary (NARSUM) and core Disability Evaluation System documents.  Attempts at obtaining additional records were unsuccessful.  The CI injured his left knee in a fall in basic training (January 2005, 16 months prior to separation).  Imaging (X-rays and MRI) was normal and he failed a trial of conservative management.  The MEB’s history and physical examination (DA Forms 2807-1 and 2808) did not identify any complaints or findings of range of motion (ROM) limitation, instability, locking, or recurrent effusions.  The MEB forwarded “left knee pain” to the PEB for adjudication.

The undated NARSUM documented unresolved pain (not quantified) with “running [and] prolonged kneeling.”  The commander’s performance statement elaborated additional functional limitations of lifting and “walking/standing over 30 minutes.”  The NARSUM physical examination recorded tenderness lateral to the patella, no effusion, no crepitus, no anterior instability (negative Lachman’s, no documentation of stress testing in other planes), and negative signs of impingement (locking).  The NARSUM did not comment on ROM, although painful motion was noted.  There was no formally measured or observed ROM evidence in the available Service file.   

The remote VA Compensation and Pension (C&P) examination of 27 March 2015 documented continued pain (unquantified) and the CI’s claim that he needed to use a brace for flare-ups.  He denied a history or subluxation, instability, or recurrent effusions.  Listed functional limitations included walking or standing longer than 5 minutes.  The physical examination recorded tenderness, crepitus, mild (specifying 0-5 millimeters) medial and lateral laxity, and no anterior or posterior laxity.  Measured ROM was flexion to 140 degrees (normal) and extension 0 degrees (normal), specifying painful motion.

The Board directed attention to its rating recommendation based on the above evidence.  The PEB rated 0% under code 5099-5003 (analogous to degenerative arthritis).  The VA (based on the remote C&P evidence) conferred a 10% rating under code 5260 (limitation of flexion) citing painful motion, and an additional 10% rating for “slight lateral instability” under code 5257 (knee, other impairment of).  Although there was no minimum compensable ROM limitation, members agreed that VASRD §4.59 (painful motion) and/or §4.40 (functional loss) was reasonably conceded in support of the minimum 10% rating.  Members agreed that there was no evidence applicable to the time of separation (and equivocal evidence at the time of the VA rating) to justify a separate rating for instability.  There was no evidence for frequent locking and effusion to support a 20% rating under code 5258, and no fracture with non-union or malunion to support a higher rating under codes 5252 or 5265.  There was thus insufficient evidence in support of a rating higher than 10% under any applicable code.  After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the Board recommended a disability rating of 10% for the left knee condition; preferring code 5010 (traumatic arthritis, defaulting to criteria of 5003).

BOARD FINDINGS:  In the matter of the left knee condition, the Board unanimously recommends a disability rating of 10%, coded 5010 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 his prior medical separation:  

CONDITION	VASRD CODE	PERMANENT RATING	
Traumatic Arthritis, Left Knee	5010	10%	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20150607, 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 XXXXXXXXXXXXXXXXXXXXX:

Reference your application submitted under the provisions of DoDI 6040.44 (Section 1554, 10 USC), PDBR Case Number PD-2015-00913.

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,

XXXXXXXXXXXXXXXXXXXXX

Attachment:
1.  Directive 
2.  Record of Proceedings 

cc:
SAF/MRBR

PDBR PD-2015-00913

MEMORANDUM FOR THE CHIEF OF STAFF

	Having received and considered the recommendation of the Physical Disability Board of Review and under the authority of Title 10, United States Code, Section 1554a (122 Stat. 466) and Title 10, United States Code, Section 1552 (70A Stat. 116) it is directed that:

	The pertinent military records of the Department of the Air Force relating to XXXXXXXXXXXXXXXXXXXXX, be corrected to show that the diagnosis in his finding of unfitness was Traumatic Arthritis, Left Knee, VASRD code 5010, rated at 10% rather than 0%.

XXXXXXXXXXXXXXXXXXXXX