RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXX	CASE:  PD-2015-02337
BRANCH OF SERVICE:  Air Force 	SEPARATION DATE:  20030801

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

CI CONTENTION:  The CI requested consideration of all MEB/PEB conditions for being unfit and rated.  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 - 20030523	VARD - 20031023	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Left Knee Pain Status Post Surgery x 4	5257	10%	Internal Derangement, Left Knee, Status Post Repair Of Medial Meniscus And Reconstruction Of Anterior Cruciate Ligament 	5259	10%	STR	
Overweight	Cat III	No VA Placement	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  10%	

ANALYSIS SUMMARY:  

Left Knee Pain.  According to service treatment records (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI underwent left knee surgery four times in the years prior to separation for a medial meniscus tear (MMT) and torn anterior cruciate ligament (ACL).  The last surgery was performed in December 2002.  Following surgery, the CI underwent rehabilitation in physical therapy (PT), but did not regain sufficient function to return to full duty.  
Following the last surgery, further treatment did not result in improvement sufficient to allow unrestricted duty.  The MEB forwarded “chronic left knee pain” for PEB adjudication.  The MEB NARSUM, performed by the treating orthopedic surgeon on 30 January 2003, 6 months before separation, noted evidence of mild instability of the ACL and episodic joint pain and grinding sensation secondary to meniscal pathology as well as chondromalacia changes.  The CI reported his knee was episodic with painful discomfort.  He complained of popping, a grinding sensation and a sensation of overextension of the knee joint.  He reported he was unable to run, jump, and march.  There were no complaints of locking or giving way.  On examination the left knee range of motion (ROM) was flexion 135 degrees (normal 140) and extension 0 degrees (normal 0).  There was no effusion.  There was no tenderness.  Varus/valgus laxity was not present, but an anterior drawer test was positive.  There was no pain or crepitus with motion noted.  He was thought to have developed chondromalacia of the knee as well as mild instability of the ACL.  He was also thought to have pain from the meniscal pathology.  He was evaluated by a civilian orthopedist on 18 June 2003, 6 weeks prior to separation, who noted a possible internal derangement of the knee, but no comment on stability of the ACL was made implying that it was stable or nearly so.  Follow up was requested after an MRI, but if done, is was not in evidence.  There was no VA Compensation and Pension (C&P) examination in evidence within the 12 months post-separation for review.  

The Board directed attention to its rating recommendation based on the above evidence.  The PEB rated the left knee condition 10%, coded 5257 (presence of ligamentous instability or laxity).  The VA rated the left knee condition 10%, coded 5259 (cartilage, semilunar, removal of, symptomatic), citing symptomatic removal of the semilunar cartilage using the service records.  Mild instability of the ACL supports a 10% rating under the 5257 code (knee, other impairment of).  Limitation of motion was not compensable.  The 5259 code (cartilage, semilunar, removal of, symptomatic) was applicable in this case and provides a 10% rating under that code for persistent pain.  After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the Board majority recommends a separation rating of 10% for symptomatic removal of the medial meniscus coded 5259 and 10% for knee instability coded 5257, for a combined rating of 20% for the left knee condition.  The Board noted that there was no indication in the record that the scars interfered with the wear of military gear.  They were not painful at the MEB examination.  Any contribution from the scars on ROM limitation was addressed above.  The Board does not recommend disability rating for scars unless their presence imposes a direct functional limitation that renders the CI unfit.  There was insufficient evidence to support this conclusion and the scar condition could not be recommended for additional disability rating.  

Contended PEB Conditions:  Overweight.  The Board’s main charge is to assess the fairness of the PEB’s determination that the contended condition was not unfitting.  Obesity is a condition not constituting a physical disability, IAW DoDI 1332.38.  Therefore, the Board has no basis for recommending it as unfitting.  After due deliberation, the Board concluded that there was insufficient cause to recommend a change in the PEB fitness determination for the contended condition and so no additional disability rating is recommended.  

BOARD FINDINGS:  In the matter of the left knee condition, the Board majority recommends a disability rating of 10%, coded 5259 IAW VASRD §4.71a.  In the matter of the left knee condition, the Board unanimously also recommends a disability rating of 10%, coded 5257 IAW VASRD §4.71a.  The single voter for dissent recommended no change and did not elect to submit a minority opinion.  In the matter of the contended overweight condition, the Board unanimously recommends no change from the PEB determinations as not unfitting.  In the matter of the contended left knee scar condition, the Board unanimously agrees that it cannot recommend it for additional disability rating.  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 ACL Instability	5257	10%	
Left Knee Medial Meniscus Tear	5259	10%	
COMBINED	20%	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20150910, 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
	
XXXXXXXXXXXXXXXXXXX

Dear XXXXXXXXXXXXXXXXXXX:

Reference your application submitted under the provisions of DoDI 6040.44 (Section 1554, 10 USC), PDBR Case Number PD-2015-02337.

	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.  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.  This will not result in any change to your separation documents or the amount of severance pay you are entitled to.  Disability severance pay is computed the same regardless of a rating of 0, 10 or 20 percent.

Sincerely,

XXXXXXXXXXXXXXXXXXX
Director
Air Force Review Boards Agency

Attachment:
1.  Directive 
2.  Record of Proceedings 

cc:
SAF/MRBR