RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXXXXX	CASE:  PD-2017-04042
BRANCH OF SERVICE:  Air Force 	SEPARATION DATE:  20051003

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E3, Traffic Management Apprentice, medically separated for “chronic left knee pain” with a disability rating of 10%.   

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 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 - 20050803	VARD - 20060824	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Left Knee Pain	5257	10%	Left Knee, Status Post Patellar Tendon Repair	5260-5024	10%	20060726	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  10%	

ANALYSIS SUMMARY:  

Chronic Left Knee Pain.  According to the service treatment record and MEB narrative summary (NARSUM), the CI underwent surgical repair of the left knee patellar tendon on 25 April 2003.  Despite physical therapy, he continued to have problems with the knee including some laxity of the patellar tendon.  On 17 June 2004, he underwent surgical reconstruction of the left knee patellar tendon.  At a rehabilitation clinic visit in August 2004, he had about 94-100 degrees flexion (normal 140) and no pain around the patellofemoral joint or with patellar compression.  X-rays showed the hardware in a good position. At a rehabilitation clinic visit in November 2004, quadriceps atrophy was noted.  Flexion was 129 degrees without instability or laxity, but there was mild patellofemoral crepitation (grinding sensation). 

The 6 December 2004 MEB NARSUM examination, 10 months prior to separation, cited an orthopedic examination from 15 November 2004 where the examiner determined he had excellent motion, strength was coming along, there was no pain and “he really likes his knee extension. He is just weak, and needs to keep working on his strength.” No NARSUM physical examination was performed.  At the 7 February 2005 an orthopedic clinic visit, the CI was permitted to return to work with a ‘no running’ profile and he was to get a brace to try to allow running.  At the 27 April 2005 orthopedic clinic examination, he could lift his leg up and essentially went to 0 degrees on extension.  Quadriceps atrophy persisted.  No diffuse tenderness around the incision site was present.  

At the 26 July 2006 VA Compensation and Pension (C&P) examination, 10 months after separation, the CI reported constant pain of the left knee without any weakness, stiffness, swelling, heat, redness, giving away, lack of endurance, locking, fatigability, or dislocation.  Physical examination showed left knee range of motion (ROM) was normal with flexion to 140 degrees and extension 0 degrees.  Joint function was not additionally limited by pain, fatigue, weakness, lack of endurance, or incoordination after repetitive use.  There was no instability or laxity of the left knee nor was there evidence of a meniscal tear.  

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).  The VA also rated the left knee condition 10%, dual coded 5260-5024 (limitation of flexion-tenosynovitis), based on the C&P examination, citing painful or limited motion of the left knee. The panel considered multiple VASRD knee and analogous codes, but all were less applicable and/or not advantageous for rating.  Therefore, there was no VASRD §4.71a rating higher than the 10% adjudicated by the PEB 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 chronic 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
3351 Celmers Lane
JBA NAF Washington, MD 20762-6435

Dear XXXXXXXXXXXXXXXX:

		Reference your application submitted under the provisions of DoDI 6040.44 (Section 1554, 10 USC), PDBR Case Number PD-2017-04042.

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 rating modification or re-characterization 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 modification of your disability rating or characterization of your separation is not warranted.  Accordingly, I accept the recommendation that your application be denied.