RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXXXX	CASE:  PD-2015-01594
BRANCH OF SERVICE:  Air Force 	SEPARATION DATE:  20060215

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E3, Signals Intelligence, medically separated for left 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 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 - 20051220	VARD - 20071024	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Left Knee Pain Associated with EPTS Recurrent Slight Lateral Patellar Subluxation	5257	10%	Subluxing Patella of the Left Knee	5299-5257	0%	20060710	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  0%	

ANALYSIS SUMMARY:  

Left Knee Pain.  According to service treatment records (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s left knee condition began in March 2005 while in boot camp, without specific injury.  Radiographic studies showed a slightly lateral patella with no significant findings.  At the time of the orthopedic clinic appointment on 19 July 2005, 7 months pre-separation, the examiner recorded some tenderness, a normal gait, and normal strength.  Left knee range of motion (ROM) was full with painful motion.  Tests for ligamentous instability and meniscus pathology were negative.  At an orthopedic consultation on 26 September 2005, 5 months pre-separation, the CI reported her patella still subluxed frequently but had not dislocated in quite a while.  On physical examination the examiner stated that there was “full range of motion 0-135 degrees,” with no effusion and no swelling.  Tests for ligamentous instability and meniscus pathology were negative.  There was abnormal patellar tracking with quadriceps (VML) muscle atrophy.  The diagnosis was left knee patella instability and the CI declined surgical correction.  The examiner recommended an administrative separation for “a condition not amounting to a disability.”  Despite treatment, the left knee condition could not be adequately rehabilitated to meet the physical requirements of the CI’s military specialty and the CI was referred for an MEB.  The MEB forwarded “left knee patella instability” for PEB adjudication.  

The MEB NARSUM examination on 2 December 2005, 2 months pre-separation, noted the CI’s complaint of constant left knee pain and that her patella sometimes moved and got “stuck to the side.”  The MEB physical examination noted quadricep muscle atrophy in the left leg as the only abnormal finding.  

At the 10 July 2006 VA Compensation and Pension (C&P) evaluation, performed 5 months after separation, the CI reported her left knee dislocated at least 3-4 times a week, especially aggravated with walking downhill or running on uneven surfaces.  She also stated she had a history of locking and swelling and occasional redness of her left knee.  Physical examination showed a normal gait, with no joint swelling, effusions, or tenderness.  Tests for ligamentous instability and meniscus pathology were negative.  ROM was normal (-10 [hyperextension] - 140 degrees) without objective evidence of pain on motion or additional limitation on repetitive testing.  

The Board directed attention to its rating recommendation based on the above evidence.  The PEB rated the left knee condition 10%, coded 5237 (knee, other impairment of), citing pain associated with an (aggravated) Existed Prior to Service (EPTS) recurrent, slight lateral patellar subluxation.  The VA rated the left knee condition 0%, analogously coded 5237, citing a non-compensable evaluation, unless there is recurrent subluxation or lateral instability of the knee which is slight.  There was no limitation of motion which supported a rating under the diagnostic codes for limitation of flexion or extension (5260, 5261).  However, there was evidence of painful motion or functional loss supporting a 10% rating (based on §4.59, §4.40 and §4.45) as adjudicated by the PEB.  There was no history of dislocated meniscus or loose body causing frequent locking with recurrent effusions (5258), or history of surgery to remove a meniscus (5259) to support a rating under the respective codes.  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).  There was therefore no VASRD §4.71a route to a rating higher than the 10% adjudicated by the PEB under any applicable code, and no grounds for additional rating based on the presence of instability.  

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 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 20150619, 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-2015-01594.

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
Director
Air Force Review Boards Agency

Attachment:
Record of Proceedings