RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXXXX	CASE:  PD-2015-01088
BRANCH OF SERVICE:  Air Force 	SEPARATION DATE:  20040820

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E5, Aerospace Maintenance, medically separated for “bilateral knee pain,” with a disability rating of 10%.

CI CONTENTION:  The CI made no specific contention.  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 - 20040528	VARD – N/A	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Bilateral Knee Pain	5257	10%	No VA Claim in Evidence	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  N/A	

ANALYSIS SUMMARY:  

Bilateral Knee Pain.  According to service treatment records and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s bilateral knee pain began in December 2001 following an automobile accident.  Radiographic studies showed revealed a probable anterior cruciate ligament (ACL) tear with possible posterior cruciate ligament tear, posterolateral meniscus tear, and a compression of the anterior cortex of the lateral tibial plateau.  In May 2002 the CI had surgery to repair a tibial plateau fracture and meniscus tear of his right knee.  The ACL was noted to be intact.  Following surgery, further treatment did not result in improvement sufficient to allow unrestricted duty.  The MEB forwarded “chronic bilateral knee pain, exacerbated by physical stress” for PEB adjudication.  

At the time of the orthopedic clinic appointment on 20 April 2004, the examiner recorded pain with activities primarily working as a crew chief on aircraft and with physical training.  The pain was primarily dully aching without substantial mechanical or stability symptoms.  On examination of the right knee there was noted a positive 1-2 grade posterior drawer sign, mildly positive McMurry test and a positive patellar grind.  Right knee magnetic resonance imaging on 22 March 2004 was notable for a tear of the posterior horn of the medial meniscus.  He was diagnosed with early post-traumatic arthritis of the right knee that will likely get worse and medial meniscus tear.  No surgical indications at that time.  The MEB NARSUM examination on 21 April 2004, 4 months prior to separation, noted complaints of a long standing history of knee pain exacerbated by physical activity, particularly with bending, jumping, climbing, and standing for prolonged periods of time.  Physical examination showed right knee laxity, a small effusion, and medial joint tenderness.  Left knee had all ligaments intact with good range of motion and no joint space tenderness or effusions.  The examiner noted a prior history of left knee surgery for a plica band release.  

There was no VA Compensation and Pension (C&P) evaluation or claim.  

The Board directed attention to its rating recommendation based on the above evidence.  The PEB combined the right and left knee conditions under a single service disability rating, coded 5257 and rated 10%.  There was no record in evidence that the CI made a claim for disability compensation with the VA.  The approach by the PEB not uncommonly reflected its judgment that the constellation of conditions was unfitting, and there was no need for separate fitness adjudications.  The Board’s initial charge in this case was therefore directed at determining if the PEB’s approach of combining conditions under a single rating was justified in lieu of separate ratings.  When considering a separate rating for each condition, the Board considers each bundled condition to be reasonably justified as separately unfitting unless a preponderance of evidence indicates the condition would not cause the member to be referred into the Disability Evaluation System or be found unfit because of physical disability.  When the Board recommends separate fitness recommendations in this circumstance, its recommendations may not produce a lower combined rating than that of the PEB.  

The Board first considered if the right and left knee conditions, having been de-coupled from the combined PEB adjudication, remained separately unfitting as established above.  In this case, both knees were considered to fail retention standards; however, Board members noted at the NARSUM examination the CI indicated the right knee was “particularly bothersome” and there was right knee laxity, effusion, and joint line tenderness.  There were no abnormal physical findings for the left knee.  Members agreed the right knee condition was separately unfitting and the left knee condition was not reasonably justified as separately unfitting and it did not meet VASRD §4.71a criteria for separate rating.  The right knee evidence of knee laxity was not sufficient to support a 10% rating under 5257 code.  There was no limitation of motion (5260, 5261), and no history of dislocated meniscus or loose body causing frequent locking with recurrent effusions (5258) to support a rating under the respective codes.  There was a history of surgery to remove a meniscus (5259) but the level of disability did not rate higher than 10%.  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).  However, there was evidence of painful motion with functional loss supporting a 10% rating (based on §4.59, §4.40 and §4.45) for the right knee condition.  After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the Board concluded there was insufficient cause to recommend a change in the PEB adjudication for the bilateral knee pain condition because it would not result in a higher rating.

BOARD FINDINGS:  In the matter of the right knee laxity 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 20150612, 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

XXXXXXXXXXXXXXXXXXXXX

Dear XXXXXXXXXXXXXXXXXXXXX:

Reference your application submitted under the provisions of DoDI 6040.44 (Section 1554, 10 USC), PDBR Case Number PD-2015-01088.

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,

XXXXXXXXXXXXXXXXXXXXX

Attachment:
Record of Proceedings