RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2017-03028
BRANCH OF SERVICE:  Air Force	SEPARATION DATE:  20060213

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

CI CONTENTION:  His condition continues to worsen and negatively impact his daily activities.  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 - 20051227	VARD - 20060614	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Anterior Left Knee Pain (Patellofemoral)	5099-5003	10%	Residuals, Torn Knee Ligament, Left Knee	5260	10%	20060501	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  60%	

ANALYSIS SUMMARY:  

Chronic Anterior Left Knee Pain.  According to the service treatment record and MEB narrative summary (NARSUM), the CI had a gradual onset of left knee pain without injury or trauma.  At the family practice appointment in November 2003, he reported knee pain had been ongoing for 2-3 years and worsened with prolonged standing or high impact activity.  On 5 March 2005, X-rays revealed mild bilateral patellar tilt, left greater than right, but no evidence of Osgood-Schlatter disease (patellar ligament inflammation).  On 25 April 2005, an MRI indicated a possible small radial tear of the lateral meniscus along with small joint effusion.  Surgery was not recommended.  At the 1 September 2005 orthopedic visit, the CI had a slightly antalgic gait favoring the left knee and mild effusion.  Range of motion (ROM) was flexion of 120 degrees (normal 140) and extension of 0 degrees (normal).  The MRI was interpreted as showing chondromalacia.  

The 12 November 2005 MEB NARSUM examination, 3 months prior to separation, noted CI complaints of continued and worsening left knee pain causing difficulty with ambulating, climbing or descending stairs, kneeling and squatting.  Physical examination showed tenderness over the medial, lateral and anterior joint line with pain on lateral movement of the patella.  Measured ROM was flexion of 70 degrees and full extension.  

At the 1 May 2006 VA Compensation and Pension (C&P) evaluation, 3 months after separation, the CI reported pain every day, but not all day, and denied swelling or locking.  Physical examination showed that the he walked with a limp.  There was tendon popping during left knee ROM testing, with flexion of 120 degrees, with pain, and extension to 0 degrees, without pain.  There was no decrease with repetitive testing.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the left knee condition 10%, coded 5099-5003 (analogous to arthritis, degenerative).  The VA also rated the left knee condition 10%, coded 5260 (leg, limitation of flexion), based on the C&P evaluation, citing residuals from torn knee ligament with popping.  Members noted 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).  Although there was diagnostic imaging evidence of a torn meniscus, there was no 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 higher 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 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 20170327, 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-2017-03028.

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