RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2017-02074
BRANCH OF SERVICE:  Air Force 	SEPARATION DATE:  20050317

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E2, Trainee, medically separated for “right knee pain” 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 - 20050309	VARD - 20050804	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Pain Right Knee 	5257	10%	Status Post Right Knee Lateral Meniscus Repair 	5259	10%	20050605	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  20%	

ANALYSIS SUMMARY:  

Right Knee Pain.  According to the service treatment record and MEB narrative summary (NARSUM), the CI underwent arthroscopic repair of a meniscal tear on 21 October 2004.  At the MEB orthopedic clinic evaluation on 21 December 2004, 4 months before separation, the CI was noted to be doing quite well post-operatively.  Physical examination showed well-healed post-surgical scars.  Knee range of motion (ROM) was flexion of 120 degrees (normal 140) and extension of 0 degrees (normal).  There was no tenderness.  

The 14 January 2005 MEB NARSUM examination, 2 months prior to separation, noted complaints of right knee pain.  On examination, the CI was sometimes able to ambulate without crutches.  The examiner noted that convalescence had been slower than anticipated by orthopedics.  Physical examination showed tenderness to the lateral joint line without swelling.  Knee ROM was flexion of 120 degrees and extension of 0 degrees.  

At the 6 June 2005 VA Compensation and Pension (C&P) evaluation, 3 months after separation, the CI reported constant knee pain, but denied incapacitation.  She was unable to jog or run and had pain with stair climbing.  Physical examination showed a normal gait without use of an assistive device.  The appearance of the knee was normal and there was no effusion.  Surgical scars of the knee were well healed.  There was increased warmth of the medial aspect of the knee, but no evidence of instability or meniscal pathology.  Knee ROM was 120 degrees of flexion and 0 degrees of extension.  There was no additional loss of motion with repetitive use.  Right knee X-rays were normal.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the right knee condition 10%, analogously coded 5257 (other impairment of knee).  The VA also rated the right knee condition 10%, coded 5259 (removal of cartilage, semilunar, symptomatic), based on the C&P examination, citing limited ROM, with warmth suggesting inflammation and reported pain.  There was no limitation of flexion or extension that supported a rating under the VASRD diagnostic codes for limitation of motion (5260 or 5261).  There was no evidence of painful motion with functional loss supporting a 10% rating (based on §4.59, §4.40 and §4.45).  However, the 5259 code was applicable in this case, and supported a 10% rating.  There was no history or evidence of dislocated meniscus or loose body causing frequent locking with recurrent effusions (5258) or fracture, nonunion or malunion of the femur or tibia (5255, 5262) to support consideration of rating under the respective codes.  Although the PEB utilized the 5257 code, there was no evidence of instability in the record for consideration of additional rating of the knee.  After deliberations, the panel arrived at the same 10% rating recommendation as the PEB under a different VASRD knee 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 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.  

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20170223, 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-2017-02074.

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