RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXX	CASE:  PD-2016-00815
BRANCH OF SERVICE:  AIR FORCE	SEPARATION DATE:  20040730

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

CI CONTENTION:  “Review all 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 - 20040606	VARD - 20050512	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Left Knee Pain	7804	10%	Post-Operative Left Knee Injury with Osteoarthritis	5010	10%	20050420	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  10% 	

ANALYSIS SUMMARY:

Chronic Left Knee Pain.  According to the service treatment record and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI underwent left knee surgery in 1999 for a torn anterior cruciate ligament with meniscal debridement.  In August 2002, previously placed hardware was surgically removed.  The 11 February 2004 MEB NARSUM examination, 6 months prior to separation, noted the CI had difficulty performing activities that required kneeling and was not able to run.  Physical examination revealed a 6-cm scar anteriorly in the harvest area of the patellar tendon graft as well as a 3-cm scar on the outside of the left knee from hardware removal.  There was joint line tenderness but no complaints of locking or giving way; instability testing was within normal limits.  Range of motion (ROM) was flexion to 130 degrees (normal 140) and extension to 0 degrees (normal) without painful motion.
At the 20 April 2004 VA Compensation and Pension (C&P) evaluation, 3 months before separation, the CI reported his knee instability caused constant pain.  Physical examination revealed a normal gait and left knee tenderness without effusion or evidence of instability.  ROM was flexion to 140 degrees and extension to 0 degrees with painful motion.

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the left knee pain condition 10%, coded 7804 (painful scar), citing DoD and VASRD guidelines.  The VA also rated the left knee pain condition 10%, coded 5010 (degenerative arthritis due to trauma), based on the C&P examination 3 months before separation, citing painful motion.  The panel agreed there was no limitation of motion which supported a rating under the diagnostic codes for limitation of flexion or extension (5260, 5261) proximate to separation.  However, there was evidence of painful motion with functional loss supporting a 10% rating (based on §4.59, §4.40 and §4.45) reported by both MEB and VA examinations.  While there was persistent pain after meniscal surgery to warrant a 10% rating under the 5259 code (cartilage, semilunar, removal of symptomatic), the panel noted that this pain symptom was already a component of the painful motion criteria noted above and if applied again would be considered pyramiding IAW §4.14 (avoidance of pyramiding).  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).  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’s adjudication for the left knee pain condition.  

BOARD FINDINGS:  In the matter of the chronic left knee pain 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 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 20160916, 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-2016-00815.

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