RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXX	CASE:  PD-2017-01115
BRANCH OF SERVICE:  Air Force	SEPARATION DATE:  20090427

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E5, Integrated Avionics Craftsman, medically separated for “bilateral knee pain” with a disability rating of 10%.  

CI CONTENTION:  Review requested of the bilateral knee condition as well as an additional condition (tinnitus) not identified by the Medical Evaluation Board (MEB) and/or 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 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 - 20090109	VARD - 20100415	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Bilateral Knee Pain	5003	10%	Right Patellofemoral Dysfunction	5260-5010	10%	20081210	
			Left Patellofemoral Dysfunction	5260-5010	10%	20081210	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  50%	

ANALYSIS SUMMARY:  

Bilateral Knee Pain.  According to the service treatment record and MEB narrative summary (NARSUM), the CI underwent left knee surgery on 13 July 2007 for a lateral release and medial femoral condyle chondroplasty which required a meniscal capsular junction resection; and right knee surgery on 28 February 2008 for chondroplasty of the patella and medial plica excision and lateral release.  Bilateral knee X-rays showed patella lateral position and chondromalacia, with minimal knee osteoarthritis.  Despite physical therapy (PT), the knee pain continued.   At a physical therapy (PT) examination on 10 July 2008, 10 months before separation, the CI complained of bilateral knee pain that radiated to the shins and ankles, and stated that “walking any distance kills me.”  After repetition, goniometrically measured range of motion (ROM) revealed right knee flexion to 82 degrees (normal 140) and extension to 0 degrees (normal), and left knee flexion to 112 degrees and extension to 0 degrees, with bilateral painful motion elicited.  The 10 September 2008 MEB NARSUM examination, 8 months before separation, noted reports of severe bilateral anterior knee pain, and physical findings showed tenderness, patellar grind, abnormal patellar tracking, trace effusion, and negative meniscus pathology testing of both knees.  Measured knee ROM was from 0-120 degrees on the right, and 0-135 degrees on the left; painful motion was not addressed.  

At the 10 December 2008 VA Compensation and Pension (C&P) examination, 5 months before separation, the CI reported constant bilateral knee pain along with weakness, stiffness, swelling, giving way, lack of endurance, locking, and fatigability.  Functional impairment included difficulty walking and prolonged standing.  Physical examination showed a normal gait and no signs of edema, effusion, weakness, tenderness, subluxation, guarding of movement, or genu recurvatum.  However, there was bilateral knee locking pain and crepitus.  Right knee ROM was from 0-100 degrees, and left knee ROM from 0-110 degrees, with painful motion on both sides.  The 17 February 2010 MES Solutions (contractor) examination, 10 months after separation, was not in available evidence, but physical findings referenced in the 15 April 2010 VA Rating Decision noted negative meniscal pathology (no bilateral knee ROM measurements).  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the bilateral knee condition 10%, coded 5003 (arthritis, degenerative).  The VA rated each knee condition 10%, dual coded 5260-5010 (leg, limitation of flexion-arthritis, due to trauma), based on the C&P examination, citing painful motion.  The VA also rated each knee condition 10%, coded 5257 (knee, other impairment), based on the MES Solutions examination, citing slight knee instability.  However, the MEB/PEB did not identify knee instability and therefore that condition is not in scope.  

The panel first considered whether each knee condition remained separately unfitting, having been decoupled from the bundled knee PEB adjudication.  Neither knee was permanently profiled or implicated by the commander’s performance; however, the MEB NARSUM recommended the CI be discharged from active duty due to his bilateral knee condition, and each knee failed retention standards.  There was not a preponderance of evidence to show that either knee condition was not reasonably justified as separately unfit, and thus the panel recommends a separate service rating for each knee condition.  Panel members agreed that while there was no compensable limitation of flexion or extension (5260 or 5261), there was sufficient evidence of painful motion with functional loss to support a 10% rating (based on §4.59, §4.40 and §4.45) for each knee.  Alternatively, a 10% rating via code 5259 (cartilage, semilunar, removal of, symptomatic) was supported for the left knee, however, this coding includes painful motion.  Other VASRD knee and analogous codes were considered, but all were less applicable and/or not advantageous for rating.  After due deliberation, considering all the evidence and mindful of VASRD §4.3 (reasonable doubt), the panel recommends a disability ratings of 10% each for the right and left knee conditions, both coded 5299-5260.  

BOARD FINDINGS:  In the matter of the bilateral knee condition, the panel recommends that each joint be separately adjudicated as follows:  an unfitting right knee condition coded 5299-5260 and rated 10%; and an unfitting left knee condition coded 5299-5260 and rated 10%, both IAW VASRD §4.71a.  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	5299-5260	10%	
Left Knee Pain	5299-5260	10%	
COMBINED	20%	

SAF/MRB
3351 Celmers Lane
JBA NAF Washington, MD 20762-6435

Dear XXXXXXXXXX:

		Reference your application submitted under the provisions of DoDI 6040.44 (Section 1554, 10 USC), PDBR Case Number PD-2017-01115.

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 in accordance with 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 the 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.