RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXX	CASE:  PD-2017-01184
BRANCH OF SERVICE:  Air Force	SEPARATION DATE:  20050919

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

CI CONTENTION:  In addition to the right knee condition, the CI requested review of 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 - 20050808	VARD - 20060310	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Right Knee Pain and Stiffness	5257-5299	10%	Anterior Cruciate Ligament (ACL) Repair	5260	10%	20060217	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  10%	

ANALYSIS SUMMARY:  

Right Knee Pain and Stiffness.  According to the service treatment record and MEB narrative summary (NARSUM), the CI underwent several surgical procedures to include open debridement and contracture release with ACL repair in 2005.  An orthopedic examination on 2 May 2005, 4 months before separation, noted right knee flexion to 80 degrees (normal 140) and extension of 5 degrees (normal 0).  Painful motion was not addressed.  The 20 July 2005 MEB NARSUM examination, 2 months prior to separation, noted complaints of chronic right knee pain and limited range of motion (ROM).  Physical examination showed mild right knee swelling without tenderness or joint laxity.  Right knee flexion was 102 degrees and extension was 5 degrees.  There was patellar crepitus noted during passive ROM testing.  A physical therapy examination on 2 May 2005, 1 month before separation, noted right knee flexion of 110 degrees and extension of 10 degrees.  Painful motion was not addressed.

At the 17 February 2006 VA Compensation and Pension (C&P) examination, 5 months after separation, the CI reported daily right knee pain and flare-ups twice weekly.  Provocative testing to elicit signs of instability or meniscal pathology was negative.  The right knee ROM study showed flexion of 88 degrees and extension of 0 degrees with painful motion.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the right knee condition 10%, analogously coded 5257-5299 (knee, other impairment).  The VA also rated the right knee condition 10%, coded 5260 (leg, limitation of flexion), based on the C&P examination, citing objective evidence of painful limitation of motion.

The panel agreed there was limitation of knee extension to support a 10% rating under code 5261 (limitation of extension), as recorded on the orthopedic, MEB NARSUM and physical therapy ROM examinations.  However, there was no compensable limitation of knee flexion.  There was sufficient evidence of painful motion with functional loss to support an alternative 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 no documented instability to support a higher rating under code 5257.  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

Dear XXXXXXXXXX:

		Reference your application submitted under the provisions of DoDI 6040.44 (Section 1554, 10 USC), PDBR Case Number PD-2017-01184.

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.