RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXX	CASE:  PD-2017-03828
BRANCH OF SERVICE:  Air Force 	SEPARATION DATE:  20050315

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E4, Munitions System Journeyman, medically separated for “left knee instability” 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 PEB, but determined 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.  Furthermore, the panel’s authority is limited to assessing the fairness and accuracy of PEB rating determinations and recommending corrections, where appropriate.  The panel’s assessment of the PEB rating determination is based on review of medical records and all available evidence for application of the Veterans Affairs Schedule for Rating Disabilities (VASRD) standards to 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, operating 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 the disability at the time of separation.  

RATING COMPARISON:  

SERVICE PEB – 20050119	VARD - 20060120	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Left Patellar Instability	5257	10%	Left patellar Instability 	5257	10%	20051011	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  10%	

ANALYSIS SUMMARY:  

Left Knee Instability.  According to the service treatment record MEB narrative summary (NARSUM), the CI underwent surgical stabilization of the left patella in February 2004.  At an orthopedic postoperative follow-up, the examiner indicated the CI’s “left knee [was] doing pretty good.”  At a physical therapy visit in May 2004, the CI stated he was normally pain-free but had mild pain with prolonged sitting.  The active range of motion (ROM) was 0-140 degrees (normal) without pain.  However, in June 2004 the CI complained of left knee pain, which felt like grinding.  At a physical therapy clinic visit later that month, the CI indicated the new onset of symptoms of left lateral and anteromedial knee pain after running on a treadmill.  Examination revealed tenderness, but ROM was within normal limits and pain-free for flexion and extension.  On 27 September 2004, the family practice examiner noted the left patella was very mobile and tender along the medial and lateral joint lines.  An apprehension test was positive.  The examiner’s assessment was patellar hypermobility.  The CI declined a second opinion.  The 7 December 2004 MEB NARSUM examination, 3 months prior to separation, noted complaints of left knee pain.   No physical examination was performed.   The examiner’s final diagnosis was patellar instability, failed attempt at stabilization.

At the 11 October 2005 VA Compensation and Pension (C&P) examination, 7 months after separation, the CI reported a loose patella with constant knee pain and occasional giving-out.  Physical examination showed a limp from the left knee, but gait was good.  There was no fluid in the knee.   The ROM evaluation showed flexion of 140 degrees with no symptoms.  Provocative testing to elicit instability or meniscal pathology was negative.
 
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 of).  The VA also rated the left knee condition 10%, coded 5257, based on the C&P examination 7 months after separation, citing slight recurrent subluxation or lateral instability of the knee.  

There was evidence of moderate, but not severe, subluxation of the patella postoperatively noted by a family practitioner who documented the left patella was very mobile and tender to palpation along the medial and lateral joint lines and an apprehension test was positive.  His assessment of the CI’s condition as patellar hypermobility supports a 20% rating under the 5257 code (knee, other impairment of).  Panel members noted that an orthopedic examination proximate to separation reported “He is very happy with it and is having no problems.”    However, there were no examination details in regard to patella mobility or ROM measurements.  At a subsequent visit the CI indicated he had knee pain and a brace did not help.  Furthermore, the NARSUM had no physical examination and the VA examination, 7 months after separation was silent in regard to patellar status specifically, but did note ACL and capsular integrity. There was no limitation of motion (5260, 5261), no history of surgery to remove a meniscus (5259), and no history of dislocated meniscus or loose body causing frequent locking with recurrent effusions (5258) to support a rating under the respective codes.  Finally, there was no fracture, non-union, or malunion of the femur or tibia to support consideration under the respective codes for knee impairment related to long bone conditions (5255, 5262).  No additional functional limitation was evidenced by the examinations.  After due deliberation, considering all the evidence and mindful of VASRD §4.3 (reasonable doubt), the panel recommends a disability rating of 20% for the left knee instability, coded 5257.

BOARD FINDINGS:  In the matter of the left knee instability, the panel or recommends a disability rating of 20%, coded 5257 IAW VASRD §4.71a.  There are no other conditions within the panel’s scope of review for consideration.  

The panel recommends that the CI’s prior determination be modified as follows, effective as of the date of the prior medical separation:  

CONDITION	VASRD CODE	PERMANENT RATING	
Left Knee Instability 	5257	20%	

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-2017-03828.
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 not appropriate under the guidelines of the Veterans Affairs Schedule for Rating Disabilities. Accordingly, the Board recommended modification of your assigned disability rating without re-characterization of your separation with severance pay.
I have carefully reviewed the evidence of record and the recommendation of the Board. I concur with that finding, accept their recommendation and direct that your records be corrected as set forth in the attached copy of a Memorandum for the Chief of Staff, United States Air Force. This will not result in any change to your separation documents or the amount of severance pay you are entitled to. Disability severance pay is computed the same regardless of a rating of 0, 10 or 20 percent.