RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2016-01107
BRANCH OF SERVICE:  AIR FORCE 	SEPARATION DATE:  20040628

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects this covered individual (CI) was a National Guard E5, Aircraft Armament Systems Craftsman, medically separated for “chronic right knee pain secondary to patellofemoral syndrome” with a disability rating of 10%.  

CI CONTENTION:  Right knee injury should have been given a higher rating.  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 - 20040505	VARD - 20041018	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Right Knee Pain…	5003-5299	10%	Right Knee Chondromalacia…	5299-5260	0%	20040920	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  0%	

ANALYSIS SUMMARY:  

Chronic Right Knee Pain.  According to the service treatment record and Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI underwent right knee surgery in August 2003 for arthroscopic debridement of the articular cartilage.  The 26 September 2003 MEB NARSUM examination, 9 months prior to separation, noted complaints of continued pain that restricted his ability to run and walk beyond one mile.  He also stated he occasionally had swelling which was relieved with ice application.  Physical examination revealed a normal gait.  The range of motion (ROM) showed normal flexion and extension with crepitus.  There was tenderness without swelling on the anterior of the right knee.  Varus and valgus strain was normal.  The anterior/posterior drawer test was negative.  Strength was 5/5.  At the orthopedic clinic appointment on 26 February 2004, 4 months prior to separation, examination showed a grade III chondromalacia of the medial and lateral patellar facets with swelling.  

At the 20 September 2004 VA Compensation and Pension (C&P) evaluation, 3 months after separation, the CI reported right knee pain rated at 8/10.  Physical examination revealed a normal gait.  ROM showed flexion of 145 degrees (normal 140) and extension of 0 degrees (normal).  There was no weakness, stiffness, swelling, instability, locking or heat.  Also, there was no objective evidence of painful motion, nor guarding or abnormal movement.

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the right knee condition 10%, coded analogously as 5003 (arthritis, degenerative), citing chronic pain secondary to patellofemoral syndrome.  The VA rated the right knee condition 0%, coded analogously as 5260, (leg, limitation flexion of), based on the C&P examination 3 months after separation, citing the absence of any limitation of motion, pain or instability.  

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).  However, the persistence of pain after meniscal surgery warranted a 10% rating under the 5259 code (cartilage, semilunar, removal of symptomatic).  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 was therefore no VASRD §4.71a 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 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.  Therefore, the panel recommends 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 20160919, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Record 

SAF/MRB
1500 West Perimeter Road, Suite 3700
Joint Base Andrews, MD  20762

XXXXXXXXXXXXXXXXXX

Dear XXXXXXXXXXXXXXXXXX:

Reference your application submitted under the provisions of DoDI 6040.44 (Section 1554, 10 USC), PDBR Case Number PD-2016-01107.

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.  Accordingly, the Board recommended no re-characterization or modification of your separation.

I have 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.  Accordingly, I accept their recommendation that your application be denied.

						Sincerely,

		

								XXXXXXXXXXXXXXXXXX
								Director
								Air Force Review Boards Agency

Attachment:
Record of Proceedings