RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2017-01640
BRANCH OF SERVICE:  Air Force 	SEPARATION DATE:  20090114

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E4, Aerospace Maintenance Journeyman, medically separated for “chronic left knee pain status post anterior cruciate ligament and medial meniscus injury with arthroscopy x 3” with a disability rating of 10%.  

CI CONTENTION:  “Knee can’t be fixed, hurts majority of time, pops and gives way, other knee hurts as well as back now, and arthritis is spreading.”  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 – 20081120	VARD – 20091009	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Left Knee Pain 	5259	10%	Left Knee Medial Meniscus Tear 	5260	10%	20090817	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  10%	

ANALYSIS SUMMARY:  

Left Knee Pain.  According to the service treatment record and MEB narrative summary (NARSUM), the CI sustained an injury to his left knee during a motor vehicle accident in September 2006.  An MRI revealed anterior cruciate ligament and medial meniscus tears.  The CI underwent three surgical repairs (October 2006, September 2007 and May 2008) and continued to have pain and duty restrictions.  At the 4 September 2008 orthopedic appointment the CI reported his knee was still hurting.  Physical examination noted “left knee shows good extension and flexion.”  There was some patellar tilt laterally with patellar compression tenderness and positive grind.  There was no evidence of instability or acute meniscal pathology.  The CI was fitted with a PTO (patellar tracking orthosis) brace.  

The 5 September 2008 MEB NARSUM examination, 4 months prior to separation, noted complaints of continued left knee pain.  The general physical examination was normal and the above orthopedic examination was referenced.  Repeat MRI performed 7 November 2008 showed all ligaments were intact but there was degenerative joint disease and a tear of the medial meniscus noted by the radiologist, which the orthopedic surgeon doubted since it had been totally removed.  He attributed the CI’s continued knee problems to loss of the meniscal cushion and severe chondral (joint cartilage) damage.  The surgeon did not recommend any further arthroscopies, but noted other more involved knee surgeries could be pursued. 

The 17 August 2009 VA Compensation and Pension (C&P) examination, 7 months after separation, was not in evidence; however the VARD provided detailed information from the examination.  The VARD indicated the CI reported pain, swelling, and stiffness of the left knee.  On physical examination there was no deformity, effusion, redness, or warmth.  There was tenderness on the medial aspect of the knee close to the patella.  Knee ROM was recorded as 5 degrees extension (0 normal) and 122 degrees flexion (140 normal).  There was objective evidence of pain with active motion.

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the left knee condition 10%, coded 5259 (cartilage, semilunar, removal of, symptomatic).  The VA also rated the left knee condition 10%, coded 5260 (leg, limitation of flexion), based on the C&P examination, citing functional loss due to objective evidence of pain during range of motion.  The 5259 code (cartilage, semilunar, removal of, symptomatic) was applicable in this case but the maximum rating under that code is 10%.  There was surgical and imaging evidence of arthritis with painful, limited motion for 10% rating for a single major joint, coded 5003; or a 10% rating was also supported for painful motion with functional loss (based on §4.59, §4.40 and §4.45).  However, these provided no ratings benefit to the CI.  There was no limitation of motion which supported a higher 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) to support a higher rating under that code.  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 route to a rating higher than the 10% adjudicated by the PEB under any applicable code.  After due deliberation, considering all of 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 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 20170306, 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-2017-01640.

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