RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXX	CASE:  PD-2017-04199
BRANCH OF SERVICE:  air force 	SEPARATION DATE:  20050805

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E4, Electrical Systems Journeyman, medically separated for “chronic pain, right knee” and “chronic pain, left knee” 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 - 20050614	VARD - 20060414	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Pain, Right Knee	5003-5099	10%	Chondromalacia Patella Right Knee	5099-5014	10%	20060104	
Chronic Pain, Left Knee	5003-5099	10%	Chondromalacia Patella Left Knee	5099-5014	10%	20060104	
COMBINED RATING:  20%	COMBINED RATING OF ALL VA CONDITIONS:  20% 	

ANALYSIS SUMMARY:  

Right and Left Knee Pain.  According to the service treatment record (STR) and MEB narrative summary (NARSUM), the CI suffered a sports injury to his right knee in March 2003, and underwent an arthroscopic debridement of the patellar ossicle in October 2004, with no meniscal or ligamental pathology found.  The knee could not be adequately rehabilitated and he was referred for an MEB.  During MEB proceedings, and after an informal PEB for the right knee only (rated 10%), he appealed for the addition of a service rating for the left knee.  Provider entries in the STR documented an atraumatic onset of left knee pain prior to the right knee surgery.  Surgery for the left knee (identical procedure to right knee) ensued in May 2005, after the informal PEB and 10 weeks before separation.  The left knee condition was incorporated in an informal reconsideration PEB (charted above).   Post-operative STR entries for the right knee documented the absence of any minimum compensable range of motion (ROM) limitation, and a normal gait, with no indication of  a persistent effusion, instability, or meniscal impingement (locking).   Post-operative entries for the left knee documented the absence of any complications and an improving course, with no evidence of any VASRD-ratable findings.  There was X-ray confirmation of degenerative changes (osteophytes) for both knees.
	
The 18 March 2005 MEB NARSUM examination, 5 months prior to separation, was directed at the right knee only as noted above.  The examiner documented persistent pain that had required profiles and work restrictions since the initial injury and that interfered with bending and lifting.  The physical examination recorded some patellar tenderness without note of effusion, instability, or impingement, and “essentially full” ROM.  An addendum directed at the left knee was conducted on 22 April 2005, a few weeks before the ensuing surgery, and noted “severe” pain “now worse than the right... making it difficult for him to walk or run or jog.”  The physical examination recorded “marked” tenderness over the patella tendon (correlated with X-ray findings of an ossicle in that location), quadriceps guarding, and a limp.  There was no elaboration of ROM or other ratable findings.  

The 4 January 2006 VA Compensation and Pension (C&P) examination, 5 months after separation, noted nonspecific bilateral knee pain interfering with running and sports.  The physical examination recorded a normal gait without specifying ratable joint findings for either knee.  Measured ROM showed flexion to 130 degrees on the right and to 125 degrees on the left (normal 140), and bilateral extension to 0 degrees (normal), specifying painful motion but no ROM degradation with repetition.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the right and left knee conditions 10% each, both coded 5003-5099 (analogous to degenerative arthritis).  The VA also rated each knee 10%, but coded 5099-5014 (analogous to osteomalacia), based on the C&P examination and citing painful motion for each rating.  Panel members agreed there no compensable limitation of flexion or extension (5260, 5261), instability (5257), frequent locking with recurrent effusions (5258), or fracture, nonunion or malunion of the femur or tibia to support consideration under the respective codes for impairment related to long bone conditions (5255, 5262) for either knee.  There were no other criteria in evidence for either knee to support a rating higher than 10% under any applicable VASRD §4.71a 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 adjudications.  There are no other conditions within the panel’s scope of review for consideration.  Therefore, the panel recommends that there be no modification or re-characterization of the CI’s disability and separation determination.

The following documentary evidence was considered:

SAF/MRB
3351 Celmers Lane
JBA NAF Washington, MD 20762-6435

Dear XXXXXXXXXX:

		Reference your application submitted under the provisions of DoDI 6040.44 (Section 1554, 10 USC), PDBR Case Number PD-2017-04199.

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.