RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXX	CASE:  PD-2015-02374
BRANCH OF SERVICE:  Air Force 	SEPARATION DATE:  20070312

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E5, Mechanic, medically separated for “left patella lateral facet chondromalacia and patellofemoral syndrome” with a disability rating of 10%.  

CI CONTENTION:  The CI stated that he was referred to the MEB for asthma, a left shoulder condition, a left knee condition, and depression (which was later diagnosed as PTSD).  He contends that he should be retired due to these disabling conditions.  The complete submission is at Exhibit A.  

SCOPE OF REVIEW:  The panel’s scope of review is defined in DoDI 6040.44.  It is limited to review of disability ratings assigned 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 or non-compensable.  Any conditions outside the panel’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 panel’s authority is limited to assessing the fairness and accuracy of PEB rating determinations and recommending corrections, where appropriate.  The panel’s assessment of the PEB rating determination 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(s) at the time of separation.  The panel 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 panel 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 - 20061208	VARD - 20070628	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Left Patella Lateral Facet Chondro-malacia and Patellofemoral Syndrome	5099-5003	10%	Left Knee Condition	5299-5260	NSC	STR	
Exertional Dyspnea and Chest Tightness, Possible Reactive Airway Disease or Asthma	Cat II	Dyspnea	6699-6602	NSC	STR	
		Asthma	6602	NSC	STR	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  NA	

ANALYSIS SUMMARY:  

Left Patella Lateral Facet Chondromalacia and Patellofemoral Syndrome.  According to the service treatment record (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s left knee condition began in 2002 after jumping off a truck while carrying a chainsaw.  Diagnostic imaging showed a lateral meniscal tear, some patellar tilt with mild subluxation and mild chondromalacia.  There was no surgical indication.  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 range of motion (ROM) evaluations in evidence which the panel weighed in arriving at its rating recommendation, with documentation of additional ratable criteria, are summarized in the chart below.  

Left Knee ROM
(Degrees)	Ortho ~9 Mos. Pre-Sep	MEB ~4 Mos. Pre-Sep	
Flexion (140 Normal)	130	“Full”	
Extension (0 Normal)	0		
Comment	Patellar grind; patellar subluxation (J sign); and tenderness (+meniscal signs)	Tenderness; patellar grind; and McMurray	
§4.71a Rating	10%	10%	

At the 1 June 2006 orthopedic clinic appointment, the CI reported that he had left anterior knee pain.  On examination he was noted to have mildly decreased ROM as indicated in the chart above.  Examinations for meniscal pathology were positive as were tests for patellar subluxation.  The examiner also noted that the CI had knee tenderness.  

At the 31 October 2006 MEB NARSUM examination, 4 months prior to separation, the CI reported “episodic tingling and numbing” in his left knee “after kneeling for long periods of time.”  He complained of pain with “climbing stairs, kneeling, running, and lifting greater than 40 pounds.”  He also reported left knee instability but denied weakness.  The MEB physical examination noted full ROM as indicated in the chart above with a normal gait and no effusion.  However, there was tenderness and examinations for meniscal pathology were positive.  Examinations for left knee instability were negative.  

There was no VA examination in evidence proximate to separation.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the left knee condition 10%, coded 5099-5003 (analogous to degenerative arthritis).  The VA did not rate the left knee condition, citing absence of medical records or examination of permanent residual or current condition (incomplete STR and missed VA examination).  

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).  There was evidence of a torn meniscus which was symptomatic that could alternatively be rated analogously to (5259), however, that rating would be no higher than 10% and offer no benefit to the CI.  There was no history of dislocated meniscus or loose body causing frequent locking with recurrent effusions (5258) for any higher meniscal rating.  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 panel concluded that there was insufficient cause to recommend a change in the PEB adjudication for the left knee condition.  

Contended PEB Conditions:  Exertional Dyspnea and Chest Tightness, Possible Reactive Airway Disease or Asthma.  The panel’s main charge is to assess the fairness of the PEB’s determination that the contended condition was not unfitting.  The contended condition was not profiled or implicated in the commander’s statement or judged to fail retention standards.  His pulmonary function test was normal and there was no performance-based evidence from the record that the condition significantly interfered with satisfactory duty performance at separation.  After due deliberation, the panel 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 and IAW VASRD §4.71a, the panel unanimously recommends no change in the PEB adjudication.  In the matter of the contended pulmonary condition, the panel unanimously recommends no change from the PEB determination as not unfitting.  There were no other conditions within the panel’s scope of review for consideration.  The panel, therefore, recommends that there be no modification or re-characterization of the CI’s disability and separation determination.  

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20150902, 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-2015-02374.

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.  The Board recommended no re-characterization or modification of your separation.

I 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.  I accept their recommendation that your application be denied.

Sincerely,

XXXXXXXXXXXXXXXXXXX
Director
Air Force Review Boards Agency

Attachment:
Record of Proceedings