RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX 	CASE:  PD-2017-01335
BRANCH OF SERVICE:  Air Force 	SEPARATION DATE:  20050103

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E5, Communications Signals Intelligence Production Craftsman, medically separated for “chronic left knee pain/weakness/instability” with a disability rating of 10%.  

CI CONTENTION:  Review all conditions.  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 - 20041109	VARD - 20051220	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Left Knee Pain/Weakness/Instability	5257	10%	Left Knee Status Post Patella Dislocation and Quadricepsplasty	5260	10%	20051102	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  80% 	

ANALYSIS SUMMARY:  

Chronic Left Knee Pain/Weakness/Instability.  According to the service treatment record and the MEB narrative summary (NARSUM), the CI underwent left knee surgery in October 1998 for recurring dislocation of the kneecap.  Her painful knee symptoms resolved after physical therapy and rehabilitation; however, her left knee symptoms returned in early 2004 during a pregnancy.  

At the 5 October 2004 MEB NARSUM examination, 3 months prior to separation, the CI’s chief complaint was “left knee pain and left leg weakness.”  Physical examination (PE) revealed tenderness about the left knee.  Range of motion (ROM) was documented as “full.”  There was minimal weakness of the left lower extremity as compared to the right.  Clinical tests for instability were stable.  There was no comment with regards to the presence of painful joint motion.  Her diagnosis remained as chronic left knee pain/ weakness/instability.  

At the 2 November 2005 VA Compensation and Pension (C&P) examination, 10 months after separation, the CI reported constant pain and swelling of the left knee that did not cause incapacitation.  Her functional impairment was difficulty in maneuvering stairs and prolonged sitting or standing.  Her PE revealed normal ROM of the left knee without additional deficits after repetition.  Clinical tests for joint instability remained stable.  

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

The panel agreed there was no objective evidence of painful motion with functional loss supporting a 10% rating (based on §4.59, §4.40 and §4.45).  There likewise was no limitation of motion which attained a 10% rating under the diagnostic codes for limitation of flexion or extension (5260, 5261).  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).  No additional functional limitation was evidenced by the examinations.  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 left knee condition.

BOARD FINDINGS:  In the matter of the chronic 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 20170308, 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-2017-01335.

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