RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2017-00930
BRANCH OF SERVICE:  Air Force	SEPARATION DATE:  20070319

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

CI CONTENTION:  No specific contention made.  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 - 20070201	VARD - 20071212	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Left Knee Pain Due to Patellofemoral Syndrome	5099-5003	10%	Status Post Left Knee Surgery	5299-5024	0%	20071011	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  0%	

ANALYSIS SUMMARY:  

Left Knee Pain Due to Patellofemoral Syndrome.  According to the service treatment record and MEB narrative summary (NARSUM), the CI’s left knee condition began in 2002 with arthroscopic bilateral knee surgery for symptomatic medial plica removal prior to entering military service.  He entered the Air Force in June 2003 and experienced recurring left knee pain.  In March 2005, he underwent another arthroscopic plica removal on his left knee.  The pain never resolved and he continued to be unable to run, ride a bicycle, squat, sit or climb stairs due to pain.  Orthopedic consultation in October 2006 stated, "No surgical intervention indicated."  

The 27 December 2006 MEB NARSUM examination, 3 months prior to separation, noted complaints of left knee pain.  Physical examination showed crepitus with patellar testing and generalized knee pain with McMurray's testing.  Physical therapy range of motion (ROM) measurements found flexion to 135 degrees (normal 140) and extension to 3 degrees (normal 0).  

At the 11 October 2007 VA Compensation and Pension (C&P) evaluation, 8 months after separation, the CI reported daily, dull, aching left knee pain which became sharp in nature with activity.  He did not use medications or any assistive devices, could walk up to a mile with minimal pain, and had no have flare-ups.  However, he was unable kneel or squat.   Physical examination showed a normal gait and no left knee tenderness, crepitus or effusion.  ROM was normal with flexion to 140 degrees and extension to 0 degrees not limited by pain, fatigue, weakness or lack of endurance following repetitive use. 

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the left knee condition 10%, coded 5099-5003 (analogous to arthritis, degenerative).  The VA rated the left knee condition 0%, coded 5299-5024 (analogous to tenosynovitis), based on the C&P examination, citing no reduced motion or pain associated with left knee motion.  Members agreed there was no limitation of motion that supported a rating under the diagnostic codes for limitation of flexion or extension (5260, 5261).  Additionally, there was no 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).  There was therefore no higher rating than 10% available under any applicable VASRD 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 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 20170221, 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-2017-00930.

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