RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2016-01185
BRANCH OF SERVICE:  Air Force 	SEPARATION DATE:  20040824

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E5, Security Forces Journeyman, medically separated for “right knee instability” with a disability rating of 20%.  

CI CONTENTION:  “All reconstructive surgeries failed.”  He also requested several other conditions not identified by the Medical Evaluation Board (MEB) and Physical Evaluation Board (PEB) be reviewed.  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 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 - 20040622	VARD - 20050330	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Right Knee Instability	5257	20%	Residuals, Status Post ACL Right Knee	5257	20%	20050305	
COMBINED RATING:  20%	COMBINED RATING OF ALL VA CONDITIONS:  20%	

ANALYSIS SUMMARY:  

Right Knee Instability.  According to the service treatment record and MEB narrative summary (NARSUM), the CI underwent right knee arthroscopy with a partial medial meniscectomy in May 2001.  He then underwent a right anterior cruciate ligament (ACL) reconstruction with a hamstring graft in June 2003 for right knee instability.  ACL stability testing showed a 2+ Lachman’s at the orthopedic evaluation on 3 March 2004, 6 months prior to separation, the CI reported chronic post-operative right knee instability.    The 10 March 2004 MEB NARSUM examination, a week later, noted complaints of recurrent right knee instability.  The CI also reported having sensation of the knee shifting with ambulation going up and down stairs.  Physical examination showed well-healed, surgical scars at the knee.  He had a 2+ Lachman’s test, a 2+ anterior drawer test, but the posterior drawer test was negative.  The right knee was stable to varus and valgus stress at 0 and 30 degrees.  He had no joint line tenderness and McMurray’s test was negative.  Right knee range of motion (ROM) showed flexion of 130 degrees (normal 140) and extension of 0 degrees (normal).  

At the 5 March 2005 VA Compensation and Pension (C&P) evaluation, 6 months after separation, the CI reported intermittent right knee pain incited by walking more than a mile or climbed more than one flight of stairs.  He also reported intermittent instability and 10/10 pain when his knee would pop out of place and he needed to manually place it back into proper alignment.  Physical examination showed a normal gait without tenderness, edema, erythema or effusion.  Right knee ROM showed painful limitation of flexion at 120 degrees and extension of 0 degrees without pain.  A Lachman’s test was reported as positive, but no numerical grade was recorded and there was mild laxity of the right knee joint with varus and valgus stress.  The CI demonstrated evidence of pain by grimacing when the tests for laxity were performed.  An MRI showed the posterior cruciate ligament was slightly buckled, but the menisci, tendons and ligaments were intact.  A small amount of joint fluid was present, probably within range of normal variation.  

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 of).  The VA also rated the right knee condition 20%, coded 5257, citing recurrent subluxation or lateral instability of the knee, which was moderate.  The panel agreed there was no evidence of severe subluxation or lateral instability to support a 30% rating under the 5257 code.  There was no limitation of motion supporting a rating under the codes for limitation of motion (5260, 5261) and no history of dislocated meniscus or loose body causing frequent locking with recurrent effusions (5258) to support a rating under that code.  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).  However, there was a history of surgery to remove a meniscus (5259), but this provided no benefit to the CI.  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 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 20160926, 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

XXXXXXXXXXXXXXXXXX

Dear Applicant:

		Reference your application submitted under the provisions of DoDI 6040.44 (Section 1554, 10 USC), PDBR Case Number PD-2016-01185.

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