RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXX	CASE:  PD-2017-00630
BRANCH OF SERVICE:  AIR FORCE	SEPARATION DATE:  20071204

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E3, Security Forces, medically separated for “left knee pain, patellofemoral syndrome” with a disability rating of 10%.

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 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 - 20071009	VARD - 20080718	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Left Knee Pain, Patellofemoral Syndrome	5099-5003	10%	Patellofemoral Pain Disorder, Left Knee	5299-5261	10%	20080512	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  10%	

ANALYSIS SUMMARY:

Left Knee Pain, Patellofemoral Syndrome.  According to the service treatment record and MEB narrative summary (NARSUM), the CI’s left knee condition was initially treated in June 2007 after reporting left knee joint pain for the last 3 months.  Left knee X-rays on 17 July 2007 were normal.  At the orthopedics evaluation on 18 July 2007 physical examination revealed mild left knee tenderness, crepitus, and patella grind.  Instability testing was negative.  Flexion was 130 degrees (normal 140) and extension was 0 degrees (normal); painful motion was not addressed.  The 29 August 2007 MEB NARSUM examination, 4 months prior to separation, noted complaints of left knee pain.  Physical examination revealed left knee swelling and instability testing was negative.  Flexion was 130 degrees and extension was 0 degrees; painful motion was present.

At the 12 May 2008 VA Compensation and Pension (C&P) Joints examination, 5 months after separation, the CI reported intermittent left knee pain in the patellofemoral joint usually associated with physical activity.  He had left knee stiffness in the morning, and did not use a cane or take medication to relieve the pain.  Activities of daily living were not affected.  Physical examination showed left knee tenderness but no swelling.  Flexion was 120 degrees and extension was 0 degrees; painful motion was present.  There was no loss of motion with repetition.  Left knee X-rays were normal.

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the left knee condition 10%, analogously coded 5099-5003 (arthritis, degenerative).  The VA rated the left knee condition 10%, analogously coded 5299-5261 (leg, limitation of extension), based on the C&P Joints examination, citing painful motion.

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, there was evidence of painful motion with functional loss supporting a 10% rating (based on §4.59, §4.40 and §4.45).  There was no history or evidence 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 those codes.  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).  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 left knee condition.

BOARD FINDINGS:  In the matter of the left 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 Record

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

Dear XXXXXXXXXX

		Reference your application submitted under the provisions of DoDI 6040.44 (Section 1554, 10 USC), PDBR Case Number PD-2017-00630.

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.