RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2017-01574
BRANCH OF SERVICE:  Air Force 	SEPARATION DATE:  20081222

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

CI CONTENTION:  Review the migraines and left knee condition as well as several other conditions not identified by the Medical Evaluation Board (MEB) 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’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 - 20081022	VARD - 20090508	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Left Knee Pain	5099-5003	10%	Left Knee S/P Meniscectomy	5259	10%	20090115	
Migraines	Not Unfitting	Migraine Headaches	8100	30%		
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  40%	

ANALYSIS SUMMARY:  

Chronic Left Knee Pain.  According to the service treatment record and MEB narrative summary (NARSUM), the CI underwent left knee arthroscopic lateral release and open tibial tubercle osteotomy in 2004.  He returned to duty, but the knee worsened and gave out after increased running.  A left knee MRI demonstrated the knee was structurally intact and essentially stable with patellar chondromalacia involving the medial facet of the patella.  The CI underwent a second left knee arthroscopic surgery with a partial meniscectomy in May 2007.  At an orthopedic examination on 27 November 2007 the CI complained of pain, especially when he jogged.  On examination, there was trace effusion, full range of motion (ROM) and good stability.  

The 12 June 2008 MEB NARSUM, 6 months prior to separation, noted complaints of 5/10 left knee pain, instability and giving way.  Physical examination showed symmetrical knees and pain-free full ROM of the left knee.  The left knee was tender with no swelling, reddening or fluid buildup.  A patellar grind test was positive (indicating possible chondromalacia), but a lateral pull test (for patellofemoral pain) was negative as was testing for ligamentous instability (Lachman).  The patellofemoral region was tender to touch superiorly and inferiorly.  Squats were successfully performed, but with “difficulty.”  At the neuro-musculoskeletal clinic appointment on 13 June 2008, 6 months prior to separation, physical examination revealed left knee ROM of 0-130 degrees (normal 0-140). 

At the 15 January 2009 VA Compensation and Pension (C&P) examination, 3 months after separation, the CI reported progressively worsening knee pain and instability.  Physical examination showed no instability, grinding, locking, or fluid buildup, but crepitus was noted.  The meniscus was reported to be surgically absent and changes consistent with Osgood-Schlatter’s disease were present.  Gait was noted to be antalgic, and ROM was recorded as 0-135 degrees with painful motion.

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated chronic left knee condition at 10%, coded 5099-5003 (analogous to arthritis, degenerative).  The VA also rated the left knee condition at 10%, coded 5259 (cartilage, semilunar, removal of, symptomatic), citing subjective complaints of pain and giving away in the left knee, with moderate weekly flare-ups.  There was objective evidence of crepitation and pain on motion.   The meniscus was surgically absent and there was a slight loss in motion. 

There was no limitation of motion which supported a rating under the diagnostic codes for limitation of flexion or extension (5260, 5261).  However, there was evidence of painful motion with functional loss supporting a 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) to support a rating under that code.  While the 5259 code was applicable in this case, the maximum 10% rating under that code would provide no benefit to the CI.  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 therefore no VASRD §4.71a rating higher than the 10% adjudicated by the PEB under any applicable code. 

Contended PEB Condition:  Migraines.  The panel’s main charge is to assess the fairness of the PEB determination that the contended condition was not unfitting.  The contended condition was profiled, but only at the ‘P2’ level (capable of all basic work commensurate with grade and position).  The migraine condition was not explicitly implicated in the commander’s statement; however, the commander did note the CI’s condition did not adversely affect his ability to do his primary duties at home station, and he worked 9-hour night shifts.  The condition was judged not to fail retention standards.  There was no performance-based evidence from the record that the 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 contended condition, so no additional disability rating is recommended.  

BOARD FINDINGS:  In the matter of the left knee condition and IAW VASRD §4.71a, the panel recommends no change in the PEB adjudication.  In the matter of the contended migraine condition, the panel recommends no change from the PEB determination as not unfitting.  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 20170227, 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-2017-01574.

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