SAF/MRB
1500 West Perimeter Road, Suite 3700
Joint Base Andrews, MD 20762

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Dear XXXXXXXXXX:

		Reference your application submitted under the provisions of DoDI 6040.44 (Section 1554, 10 USC), PDBR Case Number PD-2017-02660.

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.

						

RECORD OF PROCEEDINGS PHYSICAL DISABILITY BOARD OF REVIEW

NAME: XXXXXXXXXX		CASE: PD-2017-02660 BRANCH OF SERVICE: AIR FORCE	SEPARATION DATE: 20090102

SUMMARY OF CASE: Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E5, Financial Management and Comptroller Craftsman, medically separated for “right knee pain” and left knee pain” rated 10% each, with a combined disability rating of 20%.

CI CONTENTION:  No specific contention was made.  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 - 20081014	VARD - 20090331	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Right Knee Pain, Status-Post [S/P] Arthroscopy x2 with Meniscectomies and Removal of Loose Body	5259	10%	Degenerative Arthritis, Status Post Arthroscopy, Right Knee	5003-5259	10%	

20081029	
Left Knee Pain, S/P Arthroscopy with Partial Menisectomy and Chondro- plasty of Medial Femoral Condyle	5259	10%	Degenerative Arthritis, Status Post Arthroscopy, Left Knee	5003-5259	10%		
COMBINED RATING: 20%	COMBINED RATING OF ALL VA CONDITIONS: 60%	

ANALYSIS SUMMARY:

Right and Left Knee Pain. According to the service treatment record (STR) and MEB narrative summary (NARSUM), the CI underwent arthroscopy of the left knee with partial medial and lateral meniscectomy and chondroplasty of the medial femoral condyle in July 2005. He also underwent right knee arthroscopy with lateral partial meniscectomy and loose body removal on 6 June of 2007 for a tear of the right lateral meniscus. He had follow-up surgery of the right knee

on 14 February 2008 consisting of medial and lateral partial meniscectomies for right knee medial and lateral meniscus tears. He did very well until May-June 2008 when his pain returned laterally in both knees. On 16 June 2008, the examiner noted the CI’s symptoms were somewhat different in regard to location of the maximal pain, which was along the iliotibial band overlying the supracondylar region. An injection was given to the region of maximal pain on the left, which provided excellent relief at the time. However, he continued to have recurrent pain, which worsened with running or other high impact activities. It was determined he had reached his maximum medical improvement after three surgical attempts.

The 10 July 2008 MEB NARSUM examination, 6 months prior to separation, noted CI complaints of frequent recurrences of bilateral knee pain, rated at 5-8/10, which required restrictions in daily activities. Physical examination showed a normal gait, no tenderness of the joints or patellae, and no swelling. There was full range of motion (ROM) and normal strength of the four extremities, and he was able to stand without difficulty from a sitting position.

At the 20 October 2008 VA Compensation and Pension (C&P) examination, 3 months before separation, the CI reported bilateral knee pain, rated at 6/10, which occurred 5 times a day and was aching, sharp, and cramping in nature. The pain was elicited by physical activity and stress, but he did not have weakness, heat, redness, lack of endurance, fatigability, or dislocations. Rest and Vicodin (a narcotic/analgesic combination) relieved the pain, but he could function without medication. Physical examination showed posture and gait within normal limits. Both knees showed tenderness and guarding of movement with no signs of edema, effusion, weakness, redness, heat, or subluxation. Neither knee showed locking pain, genu recurvatum, or crepitus (grinding sensation). Right knee ROM was 5-130 degrees (normal 0-140) and left knee ROM was 0-140 degrees, with bilateral pain at the end points. Joint function was not additionally limited by pain, fatigue, weakness, lack of endurance, or incoordination after repetitive use. All ligament stability tests for both knees were within normal limits. On 31 October 2008, X-rays showed minimal left knee degenerative changes, and early, mild right knee degenerative changes.

The panel directed attention to its rating recommendation based on the above evidence. The PEB rated the right and left knee conditions 10% each, coded 5259 (cartilage, semilunar, removal of, symptomatic), citing normal gait with full ROM and normal strength. The VA also rated the right and left knee conditions 10% each, analogously coded 5003-5259 (arthritis, degenerative- cartilage-semilunar, removal of, symptomatic), based on the STR and C&P examinations, citing each knee had symptomatic removal of the semilunar cartilage. Panel members agreed that there was no limitation of flexion or extension (5260, 5261) which supported a rating under those diagnostic codes for either knee. However, there was evidence of persistence pain after meniscal surgery that warranted a 10% rating under code 5259 for each knee. There was no history or evidence of a dislocated meniscus or loose body causing frequent locking with recurrent effusions (5258), and 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 for either knee under any applicable code. 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 right and left knee conditions.

BOARD FINDINGS: In the matter of the right and left knee conditions 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 20170322, w/atchs Exhibit B.  Service Treatment Record
  Exhibit C.  Department of Veterans Affairs Record