RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXX	CASE:  PD-2015-02437
BRANCH OF SERVICE:  Air Force 	SEPARATION DATE:  20060703

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E4, Communication, Network, Switching/Crypto Systems Journeyman, medically separated  for “bilateral knee pain”  with a  disability rating of 10%.

CI CONTENTION:   The CI contends that his rating did not recognize the degenerative nature of his condition and that his sleep apnea was not rated.  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 - 20060517	VARD - 20070329	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Bilateral Knee Pain associated with Patellofemoral Disease (Chondromalacia)	5099-5003	10%	Patellofemoral Syndrome of the Right Knee	5260	0%	20070109	
			Patellofemoral Syndrome of the Right Knee	5260	0%	20070109	
COMBINED RATING: 10%	COMBINED RATING OF ALL VA CONDITIONS:  0%	

ANALYSIS SUMMARY:  

Bilateral Patellofemoral Disease.  According to the service treatment record (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s bilateral knee pain condition insidiously began and worsened over an extended period of time with activities of prolonged standing, bending, climbing, or jogging.  Radiographic studies were interpreted as demonstrating degenerative properties within both knees to include a large osteochrondroma (benign bone tumor) within the left knee.  In January 2005, the CI underwent a partial removal of two menisci in the left knee and in November 2005, his right knee was operated on to repair damaged cartilage.  Despite bilateral surgical intervention, aggressive physical therapy (PT) and activity restriction, the CI continued to have difficulty with jogging, bending, and lifting.  The MEB forwarded “bilateral knee pain” for PEB adjudication.

At the MEB NARSUM examination on 8 March 2006, 4 months prior to separation, the CI’s chief complaint was “bilateral knee pain.”  His physical examination (PE) revealed bilateral joint line tenderness.  There was no external surrounding redness, joint effusion, or evidence of instability to either knee.  Sensory and motor function of both lower extremities was normal.  At a family practice clinical encounter in June 2006, 1 month before separation, the CI reported normal movement of all extremities as well as stable knee pain which was aggravated by repetitive walking, climbing, and lifting.  His PE was normal with regards to neuro function, balance, gait and stance.  

At the 20 January 2007, VA Compensation and Pension (C&P) evaluation, performed 6 months after separation, the CI reported “…intermittent [bilateral knee] discomfort exacerbated by activity, yet tolerable”.  The CI reported no difficult with his current occupation and only mild limitations on his recreational activities.  His PE revealed crepitus in the left knee.  Range of motion of both knees was normal and repeat x-rays revealed ‘minimal joint space narrowing in the medial compartments of both knees. 

The panel directed attention to its rating recommendation based on the above evidence.  The PEB bundled both knees as a single condition and rated at 10%, analogously coded 5099-5003 (degenerative arthritis), whereas the VA separately rated both knees at 0% each coded 5260 (leg; limitation of flexion), citing evidence of “…without pain on motion and/or limitation of motion”.  

The panel first considered whether each knee condition remained separately unfitting, having decoupled them from the combined (bilateral) PEB adjudication.  Panel members carefully reviewed the chronological STR and agreed that the CI’s overall condition, surgical treatment intervention, and generally unchanging clinical symptoms would support either knee having functional limitations that contributed to the CI’s inability to perform his military duties, and accordingly, separate disability ratings are recommended.

In regards to specific rating criteria, panel members further agreed that near the time of separation, the minimal finding of bilateral knee joint line tenderness in connection with the ability to move all extremities normally, would not support any positive disability rating to either knee.  However, members also considered and agreed that the surgical description of meniscal removal in the left knee would support a 10% rating for the left knee only under VASRD code 5259 (cartilage, semilunar, removal of, symptomatic).  Therefore, after due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the panel concluded that each knee was separately unfitting and rated at 10% for the left knee and 0% for the right knee, coded under 5259 and 5003, respectively.  Additionally, the panel concluded that unbundling each knee with the above impairment percentages would not provide any additional benefit to the PEB’s current 10% rating. 

BOARD FINDINGS:  In the matter of the bilateral knee condition and IAW VASRD §4.71a, the Board unanimously recommends no change in the PEB adjudication.  There are no other conditions within the Board’s scope of review for consideration.  The Board, 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 20151012, 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-2015-02437.

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