RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXX	CASE:  PD-2017-03599
BRANCH OF SERVICE:  Air Force 	SEPARATION DATE:  20080310

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E6, Communication-Computer Systems Operator Craftsman, medically separated for “chronic left knee pain with medial collateral ligament (MCL) strain and medial meniscal tear (MMT), status post posterior cruciate ligament tear” with a disability rating of 10%.    

CI CONTENTION:  The knee has continued to worsen and affect activities of daily living.  Review of additional conditions not identified by the Medical Evaluation Board (MEB) and Physical Evaluation Board (PEB) was also requested.  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 - 20080128	VARD - 20080626	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Left Knee Pain	5257	10%	Chronic Left Knee Strain with Mild Degenerative Disc Disease (DDD)	5260	0%	200880225	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  0%	

ANALYSIS SUMMARY:  

Chronic Left Knee Pain.  According to the service treatment record and MEB narrative summary (NARSUM), the CI’s knee condition began in July 2006 after falling off a motorcycle and sustaining a valgus knee injury.  Knee MRI on 12 August 2006 showed a complete posterior cruciate ligament (PCL) tear, MCL strain and MMT.  The CI was treated conservatively with a knee brace with improvement and no surgery was recommended.  At a sports medicine examination on 10 August 2007, 7 months prior to separation, the CI reported pain with running and that his knee gave out one to two times per week.  He denied swelling, but reported locking every morning.  Physical examination was essentially unchanged with full knee ROM noted and mild evidence of PCL insufficiency.  There was no effusion, muscle atrophy, varus/valgus laxity, or evidence of meniscal pathology.  

At the MEB NARSUM examination 4 days later, the CI reported left knee pain and instability.  Physical examination showed no tenderness or loss of motion.  Strength was normal.  There was anterior/posterior laxity noted.  Repeat MRI on 28 August 2007 was unchanged.  The 10 October 2007 MEB NARSUM addendum by sports medicine, 5 months prior to separation, noted that because the CI’s knee symptoms had changed, he was contacted twice and offered referral for surgical consideration, declined surgery at the time.  The 15 December 2007 MEB NARSUM addendum examination, 3 months prior to separation, also by sports medicine, reiterated the same information.  

At the 25 February 2008 VA Compensation and Pension (C&P) examination, one month before separation, the CI reported intermittent left knee pain, three to four times per week, lasting 1 to 2 hours.  He reported wearing a brace for most activities.  He denied any effect on his daily activities and had no missed workdays in the last 12 months due to the condition.  Physical examination showed a normal gait, no tenderness or effusion and a stable joint.  There was no evidence of meniscal pathology.  Knee ROM was normal after repetition, without pain.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the left knee condition 10%, coded 5257 (knee, other impairment), “citing mild posterior drawer/sag and positive Lachman’s test, but otherwise normal examination.”  The VA initially rated the chronic left knee condition 0%, coded 5260 (leg, limitation of flexion), based on the C&P examination, citing degenerative changes of the left knee joint with no objective finding of limited or painful motion.  The CI filed a Notice of Disagreement and a 7 May 2009 Decision Review Officer Decision increased the rating to 10%, coded 5260-5003 (limitation of leg flexion-degenerative arthritis) for arthritis with limitation of motion.  

In deliberating a rating under the 5257 code (knee, other impairment; recurrent subluxation or lateral instability), the panel considered use of a knee brace, and noted the objective examination findings by all examiners of at most mild posterior instability.  The panel agreed that this evidence most accurately described “slight” instability under the 5257 code.  It was noted that the PEB rated the knee condition at 10% under the 5257 instability code, but that knee pain was also accounted for in the adjudication and contended by the CI.  Members concluded that consideration of dual coding for painful motion and instability was appropriate.  However, at the MEB and VA examinations, there was no painful motion or limited motion of the left knee documented.  The panel concluded that there was insufficient evidence to support dual coding for painful or limited ROM and instability.  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 left knee condition.  

BOARD FINDINGS:  In the matter of the chronic 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.  

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

XXXXXXXXXX
XXXXXXXXXX
XXXXXXXXXX

Dear XXXXXXXXXX:

	Reference your application submitted under the provisions of DoDI 6040.44 (Section 1554, 10 USC), PDBR Case Number PD-2017-03599.

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.