RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXX	CASE:  PD-2017-01105
BRANCH OF SERVICE:  air force	SEPARATION DATE:  20060306

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects this covered individual (CI) was a National Guard E6, Security Forces Craftsman, medically separated for “right knee pain” with a disability rating of 10%.  

CI CONTENTION.  Review all conditions.  The CI also requested review of additional conditions not identified by the Medical Evaluation Board (MEB) and Physical Evaluation Board (PEB) was requested.  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 - 20051028	VARD – 20060829	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Right Knee Pain	5003-5259	10%	Right Knee Degenerative Joint Disease 	5010-5260	10%	20061012	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  50%	

ANALYSIS SUMMARY:

Right Knee Pain.  According to the service treatment record (STR) and MEB narrative summary (NARSUM), the CI underwent right knee surgery with partial medial meniscectomy and chondroplasty in March 2003 following a history of right knee pain and locking.  At the 31 August 2004 MEB NARSUM, 18 month prior to separation, the CI reported right knee pain and inability to run or walk for extended periods.  Physical examination revealed right knee crepitus, absent right knee deep tendon reflexes and “limited” right knee flexion.  The 23 August 2005 orthopedic examination, 6 month prior to separation, recorded right knee tenderness, moderate crepitus with ROM and a minimally positive McMurray (meniscal) test.  The impression indicated evidence of Grade IV cartilage loss of the medial femoral condyle, patella and trochlear groove.  

According to the 4 October 2005 family practice note, the CI had an acute twisting injury leading to right thigh and knee pain and swelling.  A follow-up on 8 October 2005 indicated interval improvement with findings of swelling above and below the right knee with a final diagnosis of right quadriceps strain-improving, and right pre-patellar bursitis.  

During the 12 October 2006 VA Compensation and Pension (C&P) examination, 7 months after separation, the CI complained of right knee pain with and without motion.  X-rays revealed evidence of marked degenerative disease including osteophytes and flattening of the articular surface.  Physical examination revealed an antalgic gait secondary to bilateral knee pain.  Right knee extension was -15 degrees from neutral (lacking 15 degrees of extension to neutral (normal 0) and flexion was 110 degrees (normal 140) with painful motion.  McMurray’s test was positive.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the right knee condition 10%, dual coded 5003-5259 (degenerative arthritis – removal of semilunar cartilage, symptomatic).  The VA initially rated the right knee condition 10%, dual coded 5010-5260 (traumatic arthritis causing limitation of leg flexion), based on the STR, citing painful motion.  The VA increased the right knee rating to 20%, coded 5261 (limitation of leg extension), based on the C&P examination, citing limitation of extension.  

The panel deliberated the probative value of the examinations in evidence.  The STR did not contain goniometric or quantitative right knee ROM evaluations proximate to separation; therefore, the VA examination was adjudged to have the highest probative value for rating at separation.  The VA examination recorded limitation of right knee extension to -15 degrees supporting a 20% rating under code 5261.  There was no limitation of flexion that supported a rating under (5260), and 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).  As meniscal ratings include painful limited motion, no dual rating was supported.  After due deliberation, and considering all the evidence, the panel recommends a disability rating of 20% for the right knee condition, coded 5259-5261.  

Contended PEB Condition:  Left Knee Pain Osteoarthritis or Chondromalacia.  The panel’s main charge is to assess the fairness of the PEB determination that the left knee condition was not unfitting.  The original MEB was for “Knee pain; Osteoarthritis” and did not specify the right knee, left knee or both knees.  The 1 December 2004 PEB and 7 March 2005 Formal PEB both included “mild chondromalacia of left knee” as not unfitting.  The 28 October 2005 Formal PEB specified only the right knee as unfitting and rendered a de facto “not unfitting” determination as the left knee was not included under the diagnosis or remarks sections.  There was no history of left knee surgery or specific left knee injury.  Although it was noted in 2004 on AF Form 348 (LOD) that the CI was “having problems with her left knee as a result of favoring it while her right knee was recovering,” there were scant STR notes for treatment of the left knee.  The profile, commander’s statement, and MEB did not specify either knee; however, multiple PEBs adjudicated the left knee as not unfitting.  There was no performance-based evidence from the record that the left knee condition significantly interfered with satisfactory duty performance at separation.  After due deliberation, the panel concluded there was insufficient cause to recommend a change in the PEB fitness determination for the left knee condition, so no additional disability rating is recommended.  

BOARD FINDINGS:  In the matter of the right knee condition, the panel recommends a disability rating of 20%, coded 5259-5261 IAW §4.71a.  In the matter of the contended left knee condition, the panel agrees it cannot recommend it for additional disability rating.  There are no other conditions within the panel’s scope of review for consideration.  

The panel recommends the CI’s prior determination be modified as follows, effective the date of medical separation:

CONDITION	VASRD CODE	PERMANENT RATING	
Right Knee Pain 	5259-5261	20%	

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-2017-01105.

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 not appropriate under the guidelines of the Veterans Affairs Schedule for Rating Disabilities.  Accordingly, the Board recommended modification of your assigned disability rating without re-characterization of your separation with severance pay. 

I have carefully reviewed the evidence of record and the recommendation of the Board.  I concur with that finding, accept their recommendation and direct that your records be corrected as set forth in the attached copy of a Memorandum for the Chief of Staff, United States Air Force.  This will not result in any change to your separation documents or the amount of severance pay you are entitled to.  Disability severance pay is computed the same regardless of a rating of 0, 10 or 20 percent.