RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXX	CASE:  PD-2016-01296
BRANCH OF SERVICE:  AIR FORCE	SEPARATION DATE:  20040517

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E4, Aerospace Maintenance Journeyman, medically separated for “chronic right knee pain” with a disability rating of 10%.

CI CONTENTION:  The CI made no specific contention.  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 - 20040304	VARD - 20050614	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Right Knee Pain	5257	10%	Right Knee Strain	5260-5024	10%	20050107	
RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  30%	

Chronic Right Knee Pain.  According to the service treatment record and Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s right knee pain began in 2001 while performing a physical fitness bike test.  He underwent an osteochondroma excisional biopsy (removal of cartilage overgrowth) on 26 June 2001 and post-operative rehabilitation was unsuccessful, with the CI experiencing paresthesias and increased right knee and lower leg pain.

The 25 October 2002 MEB NARSUM examination, 19 months prior to separation, noted complaints of increased right knee pain.  Physical examination showed knee tenderness but no crepitus, knee popping or ligamentous instability.  Range of motion (ROM) was not quantified but noted to be approximately “25 degrees short of full extension” with reduced flexion; painful motion was not addressed.  
The 23 October 2003 MEB NARSUM examination, 7 months prior to separation, noted complaints of continued right knee sensitivity and occasional pain radiating down to the foot.  Physical examination showed knee tenderness and mild crepitus, but no edema, knee popping or ligamentous instability.  ROM was again not quantified but noted as “30 degrees short of full extension;” flexion and painful motion were not addressed.  

At a 3 November 2003 primary care visit, 7 months prior to separation, the CI complained of right knee pain and used a cane.  Physical examination showed a right-sided antalgic gait, some edema, but no ligamentous instability.  Flexion was to 100 degrees (normal 140) and extension to 0 degrees (normal); painful motion was not addressed.  The 5 February 2004 MEB NARSUM addendum, 3 months before separation, noted no significant changes from October 2003. 

At the 07 January 2005 VA Compensation and Pension (C&P) general evaluation, 8 months after separation, the CI reported bilateral knee stiffness and pain in front and in back of the knees.  Physical examination showed right knee appearance within normal limits.  Ligamentous instability and meniscus testing were normal but locking pain was present.  ROM measurements were flexion to 130 degrees and extension to 0 degrees with painful motion.  ROM was not additionally limited by repetition, fatigue, weakness and incoordination. 

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the right knee condition 10%, coded 5257 (knee, other impairment, recurrent subluxation or lateral instability).  The VA also rated the right knee condition 10%, analogously coded 5260-5024 (leg, limitation of flexion-tenosynovitis) based on the C&P examination 8 months after separation, citing functional loss and painful motion.  Members noted the disparity between the two MEB NARSUMs and determined the primary care examination, corroborated by the C&P evaluation, had the highest probative value since both documented quantified ROMs and were most proximate to separation.  The panel agreed that neither primary care nor C&P examinations recorded a limitation of flexion or extension to support the minimum compensable rating under respective codes 5260 or 5261.  These same examinations did not show the presence of ligamentous instability or laxity (5257), and there was no history 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 the respective codes.  There was no fracture, non-union, or malunion of the femur or tibia to support consideration under the respective codes for knee impairment related to long bone conditions (5255, 5262).  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 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 20161004, with attachments
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

SAF/MRB

XXXXXXXXXXXXXXXXXXX

Dear XXXXXXXXXXXXXXXXXXX:

Reference your application submitted under the provisions of DoDI 6040.44 (Section 1554, 10 USC), PDBR Case Number PD-2016-01296.

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