RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXX	CASE:  PD-2017-01050
BRANCH OF SERVICE:  Air Force	SEPARATION DATE:  20070305

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E4, Explosive Ordnance Disposal Journeyman, medically separated for “seronegative inflammatory arthritis, right knee” with a disability rating of 10%.  

CI CONTENTION:  Review requested of the knee as well as additional conditions not identified by the Medical Evaluation Board (MEB) and Physical Evaluation Board (PEB).  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 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 - 20070119	VARD - 20080403	
Condition	Code	Rating	Condition	Code	Rating	Exam	
…Inflammatory Arthritis, Right Knee	5099-5002	10%	Service Connection for Right Knee Arthritis and Synovitis, Status Post  Arthroscopic·Synovectomy with Scars	5020	10%	20080105	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  20%	

ANALYSIS SUMMARY:  

Right Knee Inflammatory Arthritis.  According to the service treatment record (STR) and MEB narrative summary (NARSUM), the CI’s right knee arthritis began in December 2005 with pain and swelling, and he underwent a synovectomy and biopsy which revealed "chronic lymphocytic inflammation consistent with autoimmune or chronic infectious synovitis.”  He was then referred to a rheumatologist in July 2006, and further diagnosed with “seronegative inflammatory mono-arthritis of the right knee.”  Despite physical therapy and oral medication, his pain remained, and he was eventually started on methotrexate (disease-modifying agent).  A primary care encounter on 11 September 2006, 5 months prior to separation, revealed right knee tenderness, swelling and effusion, but normal range of motion (ROM), with pain.  The 16 November 2006 MEB NARSUM examination, 4 months before separation, noted CI complaints of right knee pain and swelling.  Physical examination revealed a small medial right knee effusion, but no ballottement, erythema, increased warmth or neurological deficits.  Knee ROM was full, but painful motion was not addressed.  

At the 5 January 2008 VA Compensation and Pension (C&P) examination, 10 months after separation, the CI reported right knee swelling, which was reduced substantially with the methotrexate.  He could run about 6 miles once or twice a week before the knee began to ache, and although he had a buckling sensation after surgery, this went away, and he did not experience any giving way or locking.  He denied any history of joint swelling elsewhere.  The examiner noted a normal gait and ambulation, and no knee instability.  There was a slight amount of swelling around the kneecap, and ROM was normal with pain upon reaching terminal range.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the right knee condition 10%, analogously coded 5099-5002 (arthritis rheumatoid (atrophic)), citing arthritis limited to the right knee and no systemic or active disease process.  The VA also rated the right knee condition 10%, but coded 5020 (synovitis), based on the STR and C&P examinations, citing painful or limited motion of a major joint or group of minor joints and X-ray evidence of minimal osteoarthritic changes.  Panel members first agreed that the pre-separation examinations had greater probative value due to their proximity to separation.  There was no  limitation of flexion or extension to support minimal ratings under diagnostic codes 5260 or 5261, but there was evidence of painful motion supporting a maximum 10% rating (§4.59).  There was no history or evidence of dislocated meniscus or loose body causing frequent locking with recurrent effusions to support a rating under code 5258, and 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 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.  

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

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Dear XXXXXXXXXX:

		Reference your application submitted under the provisions of DoDI 6040.44 (Section 1554, 10 USC), PDBR Case Number PD-2017-01050.

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.