RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2017-00491
BRANCH OF SERVICE:  AIR fORCE	SEPARATION DATE:  20090727

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E4, Munition System Journeyman, medically separated for “chronic right 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 Medical Evaluation Board (MEB), but determined by the PEB 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.  The panel’s authority is limited to assessing the fairness and accuracy of PEB rating determinations and recommending corrections when appropriate.  The panel’s assessment of the PEB rating determination is based on review of medical records and all available evidence relevant to application of the Veterans Affairs Schedule for Rating Disabilities (VASRD) standards for 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, which operates 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 disability at the time of separation.

RATING COMPARISON:  

SERVICE PEB – 20090507	VARD - 20090910	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Right Knee Pain	5257	10%	History of Right Knee ACL Tear 	5260-5010	10%	20090813	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  20%	

ANALYSIS SUMMARY:  

Chronic Right Knee Pain.  According to the service treatment record and MEB narrative summary (NARSUM), the CI underwent a right ACL (anterior cruciate ligament) reconstruction with partial lateral meniscectomy in November 2006.  On 27 March 2008, the CI underwent a high tibial osteotomy due to continued laxity to correct a congenital misalignment.  After surgery the CI had reduced laxity, however, he continued to have right knee pain that limited his activities.

The 27 February 2009 MEB NARSUM examination, 5 months prior to separation, noted complaints of persistent pain along the inferior right knee.  Physical examination showed a normal gait with no joint line or peripatellar tenderness.  Range of motion (ROM) was normal.  Patellar grind test was pain free, anterior drawer and Lachman (ligament integrity tests) showed a solid endpoint.  McMurray test (meniscal pathology) had no pain, clunk, lock or catch.

At the 13 August 2009 VA Compensation and Pension (C&P) evaluation, 1 month after separation, the CI reported continued daily pain with certain activities.  Physical examination showed gait slightly favoring the right leg and a “slight” anterior drawer sign with good endpoint.  ROM was flexion to 125 degrees (normal 140) and extension to 0 degrees (normal); painful motion was not addressed.  There was no change in ROM after repetition.

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).  The VA also rated the right knee condition 10%, coded 5260-5010 (leg, limitation of flexion – arthritis, due to trauma), based on the C&P examination 1 month after separation, citing arthritis which caused painful or limited motion of a major joint.

There was a history of surgery to remove a meniscus (5259) which was symptomatic to support a 10% rating.  There was no evidence of moderate subluxation or lateral instability to support a 20% rating under code 5257 (knee, other impairment).  There was no 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 the respective codes.  Finally, 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 no VASRD §4.71a rating higher than the 10% adjudicated by the PEB.  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 20170217, 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 XXXXXXXXXXXXXXXXXX:

		Reference your application submitted under the provisions of DoDI 6040.44 (Section 1554, 10 USC), PDBR Case Number PD-2017-00491.

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