RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXX	CASE:  PD-2016-00303
BRANCH OF SERVICE:  Air Force 	SEPARATION DATE:  20081114

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E5, Munitions Systems Craftsman, medically separated for “chronic right knee pain, patellofemoral syndrome, status-post arthroscopy with debridement of medial shelf plica” with a disability rating of 0%.   

CI CONTENTION:  The CI contends his condition continues to worsen and affect his daily activities.  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 - 20081015	VARD – 20090618	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Right Knee Pain…	5299-5261	10%	Right Knee Patellofemoral Pain Syndrome	5299-5261	0%	20090116	
COMBINED RATING: 10%	COMBINED RATING OF ALL VA CONDITIONS:  0% 	

ANALYSIS SUMMARY:  

Chronic Right Knee Pain.  According to the service treatment record (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI underwent right knee surgery in January 2008 for medial plica (fold of tissue) syndrome.  At the time of the Orthopedic clinic appointment on 6 June 2008, 5 months prior to separation, the CI reported he was doing well until he fell while operating his motorcycle.  He continued to have right knee pain when running or performing strenuous activities.  On examination there was no effusion, deformity or soft tissue damage about the knee.  Tenderness was present on the inner aspect of the right knee.  Clinical maneuvers to assess joint instability were normal.  Range of motion (ROM) of the right knee was near normal; lacking 5 degrees of flexion (135 versus normal 140 degrees).  Joint strength and surrounding sensation was normal.  

The 25 July 2008 MEB NARSUM examination, 4 months prior to separation, noted complaints of increased knee pain while running, kneeling, or maneuvering stairs.  He described a sensation whereby his “knees feel wobbly.”  He denied significant work limitations except for the inability to carry heavy objects upstairs. There were no complaints of locking or giving way. His physical examination (PE) revealed a normal gait and full ROM of both knees.    

At the 16 January 2009 VA Compensation and Pension (C&P) evaluation, 2 months after separation, the CI reported bilateral knee pain; worse with walking on stairs or when performing exercise.  On PE, there was no tenderness, swelling, effusion, crepitus, limited motion or signs of meniscal pathology or impingement.  He exhibited full ROM of both knees.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the right knee pain condition 10%, analogously coded 5299-5261 (limitation of extension).  Utilizing the same coding scheme, the VA rated the right knee condition at 0% based on the C&P examination 2 months after separation, citing full ROM and no painful ROM.   The MEB and the VA recorded right knee flexion as full.  There was no limitation of extension that supported a rating under the VASRD diagnostic code for limitation of extension (5261).  There was no history or evidence 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 those codes.  There was no fracture, nonunion or malunion of the femur or tibia to support consideration under the respective codes for knee impairment related to long bone conditions (5255, 5262).  No additional functional limitation was evidenced by the examinations.  There is therefore no VASRD §4.71a route to a rating higher than the 10% adjudicated by the PEB under any applicable code.  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 right knee condition.

BOARD FINDINGS:  In the matter of the right knee condition and IAW VASRD §4.71a, the panel unanimously recommends no change in the PEB adjudication.  There are 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 20160705, 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-2016-00303.

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,

Attachment:
Record of Proceedings