RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2017-02019
BRANCH OF SERVICE:  Air Force 	SEPARATION DATE:  20050823

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E5, Electrical Systems Craftsman, medically separated for “chronic left knee pain” with a disability rating of 20%. 

CI CONTENTION:  In addition to his unfitting left knee, the CI requested review of his right knee and an additional condition 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 - 20050707	VARD - NA	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Left Knee Pain	5257	20%	No VA Examination Proximate to Separation in Evidence	
Right Knee Pain	Not Unfitting		
COMBINED RATING:  20%	COMBINED RATING OF ALL VA CONDITIONS:  NA	

ANALYSIS SUMMARY:  

Chronic Left Knee Pain.  According to the service treatment record (STR) and MEB narrative summary (NARSUM), the CI underwent an anterior cruciate ligament (ACL) reconstruction of his left knee in 2002.  He developed recurrent pain and underwent a second procedure (arthroscopic notchplasty for ACL impingement) in October 2004, 10 months before separation.  There was no meniscal or other ligamental pathology found by MRI or in orthopedic notes.  There was ample documentation in post-operative STR entries of normal gait and range of motion (ROM), and the absence of persistent effusion, instability, or impingement (locking).  There was no STR documentation of more significant ROM limitation or evidence contrary to the above ratable findings.  All of the preceding STR evidence was fully corroborated in a detailed final 8 April 2005 orthopedic evaluation.

The 5 June 2005 MEB NARSUM examination, 3 months prior to separation, documented “daily” knee pain that interfered with climbing, kneeling, and running.  There was no note of subjective locking or instability.  The physical examination recorded “mild” tenderness, 4-plane stability to stress testing, and “essentially full” ROM.  There was no note of gait disturbance, use of a knee brace, persistent effusion, or impingement.  There was no VA rating examination or other probative evidence temporally proximate to separation.

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the left knee condition 20%, coded 5257 (knee impairment, other), that rates for recurrent subluxation and instability.  The PEB cited “slight to moderate” chronic pain, although the 20% criterion for code 5257 is “moderate” instability (thus appearing to be a liberal analogous application of the code representing a favorable concession).  The panel agreed, given the absence of any post-operative instability in evidence, that a higher rating under code 5257 was not reasonably recommended.  

There was no limitation of motion which supported a rating under the applicable codes for limitation of flexion or extension (5260, 5261).  Neither was there 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 therefore no support for a rating higher than 20% under any applicable VASRD §4.71a code.  After due deliberation, considering all 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.  

Contended PEB Condition:  Right Knee Pain. The panel’s main charge is to assess the fairness of the PEB determination that the contended condition was not unfitting.   The first presentation for right knee pain in the available STR was in March 2005, 5 months before separation, noted as a chronic complaint without a history of trauma.  The orthopedic consultant attributed the “new problem” to early arthritic disease not yet visible on X-ray.  The orthopedic examination documented “full” flexion and extension associated with “a mild degree of discomfort” and no effusion, instability, or impingement.  The NARSUM examiner stated, “The right knee exam is essentially benign.”  There was no documentation by either examiner, or any STR provider, of functional impairment directly attributable to the right knee.  The MEB submission was “chronic left knee pain with recently developing right knee pain.”  The L4 profile did not designate a specific condition, nor did the commander’s performance statement.  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 right knee 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 right knee 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 there be 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 20170226, 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-2017-02019.

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,

		

								

Attachment:
Record of Proceedings