RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXX	CASE:  PD-2016-01037
BRANCH OF SERVICE:  Air Force	SEPARATION DATE:  20040427

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E5, Instructor Imagery Analysis Craftsman; and Security Forces Journeyman, medically separated from the for “chronic [right] knee pain and osteochondral defect” with a disability rating of 20%.

CI CONTENTION:  Current condition supports a higher rating.  Additional unfitting conditions were not considered.  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 - 20040311	VARD - 20041126	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic [Right] Knee Pain and Osteochondral Defect	5257	20%	Osteochondritis Dessicans, Right Knee	5247	10%	20041028	
COMBINED RATING:  20%	COMBINED RATING OF ALL VA CONDITIONS:  40%	

ANALYSIS SUMMARY:

Right Knee.  According to the service treatment record (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s right knee condition began in 1987 after playing football and was re-injured while running and performing the obstacle course in August 1990.  He underwent seven surgical procedures on the right knee from 1999 to August 2003.  The 11 December 2003 and 27 January 2004 MEB NARSUM examinations, 3 and 5 months prior to separation, noted complaints of chronic, 5/10 right knee pain.  Physical examination showed normal motor strength was 5/5.  Instability tests were negative.  Range of motion (ROM) was flexion to 130 degrees (normal 140) and extension 0 (normal 0) with “significant” crepitus throughout ROM.  During the 27 February 2004 primary care visit, 2 months before separation, physical examination showed normal gait and motor strength.  There was no right knee instability.  There was patella crepitus.  ROM was noted as not full; measurements and painful motion were not cited.  

At the 28 October 2004 VA Compensation and Pension (C&P) evaluation, 6 months after separation, the CI reported daily-constant right knee pain.  Physical examination showed crepitus; 2+ lateral knee instability; and moderate quadricep muscles atrophy and varus deformity.  Repetitive ROM was flexion to 90 degrees and extension 1 (normal 0) with painful motion.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the right knee condition 20%, coded 5257 (knee, other impairment).  The VA rated the right knee condition 10% for right knee instability, coded 5257, based on the C&P examination 6 months after separation, citing a 75% decrease in motion with flare-ups. The VA also rated the right knee osteochondral defect 10%, coded 5010-5260 (arthritis due to trauma-leg limitation of flexion) citing painful motion and functional loss.  There was no limitation of motion (5260, 5261) to support a rating under these respective codes.  There was likewise no fracture, nonunion or malunion of the femur or tibia to support consideration under the 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 20% adjudicated by the PEB under any applicable code.  Although the VA rated the right knee instability, there was no evidence of right knee instability within the service treatment record, evidenced on the NARSUM examination, nor adjudicated by the PEB; therefore, right knee instability is beyond the panel’s scope of review. Or pain unfitting, instability not unfitting.  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 chronic right knee pain and osteochondral defect 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 20160915, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment

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-2016-01037.

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