RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXX	CASE:  PD-2017-04396
BRANCH OF SERVICE:  air force	SEPARATION DATE:  20050408

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E5, Recruiter, medically separated for “chronic left knee pain” with a disability rating of 10%.   

CI CONTENTION:  Review requested of the left knee condition as well as several other conditions not identified by the Medical Evaluation Board (MEB) and Physical Evaluation Board (PEB).  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 - 20050112	VARD – 20060510	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Left Knee Pain	5003	10%	Tricompartmental Arthritis, Left Knee with Atrophy of Calf Muscle	5261	20%	20060203	
			Tricompartmental Arthritis, Left Knee	5260	10%	20060203	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  30%	

ANALYSIS SUMMARY:  

Chronic Left Knee Pain.  According to the service treatment record and MEB narrative summary (NARSUM), the CI underwent left knee surgery with debridement of synovitis in 1996.  He had good relief of left knee pain and swelling until 2001, when he underwent a second surgical procedure with evaluation under anesthesia (the surgeon found no left knee pathology).  Athough the pain and swelling persisted, orthopedics indicated he was no longer a surgical candidate.  In October 2002, X-rays revealed internal derangement of the left knee with synovitis, and a month later, an MRI showed serosynovitis with possible osteochondral defect and meniscal tear.  Left knee X-rays in March 2004 showed mild narrowing of the medial compartment and small tricompartmental osteophytes with a large joint effusion.  Laboratory tests in March 2004 showed a minimally elevated rheumatoid factor of 30, and multiple rheumatology evalutions from March 2004 to August 2004 showed persistent effusion described as moderate to large.  

During the 19 September 2004 MEB NARSUM examination, 7 months prior to separation, the CI reported chronic left knee pain and swelling that prevented him from running, and made activities involving repetitive knee bending difficult.  Physical examination showed a noticeable limp favoring the left lower extremity because he was not bending the left knee at a normal angle.  There was significant left knee tenderness along the medial and lateral joint lines and discomfort with valgus stress, but no ligamentous instability. Left knee range of motion (ROM) testing showed extension-to-flexion of 0-100 degrees (normal 0-140).    

At the 3 February 2006 VA Compensation and Pension (C&P) examination, 10 months after separation, the CI worked as an office manager for an industrial construction company.  He reported left knee buckling, give-way, stiffness, pain, swelling, antalgic gait, decreased strength and a sensation of discomfort in the left thigh.  He denied fatigue, lack of endurance or incapacitation from the left knee condition and reported the joint was stable.  Physical examination showed edema, effusion and heat with weakness after repetitive use, but no redness.  The ROM study revealed flexion of 120 degrees (normal 140) and extension of 15 degrees (normal 0), with crepitus and decreased strength (4/5).   The right knee showed 150 degrees of flexion and 0 degrees of extension.  Although the examiner noted “additional limitation secondary to pain, fatigue, lack of endurance following repeat use of the left knee,” this was not quantified.  Provocative testing for instability or meniscal pathology were not performed because they were too painful.  There was 3 cm of left calf atrophy when compared to the right.  Radiographic studies of the left knee showed osteoarthritic changes.

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the left knee condition 10%, coded 5003 (degenerative arthritis).  The VA dual rated the left knee condition as follows: 20%, coded 5261 (limitation of leg extension), based on the C&P examination, citing extension limited to 15 degrees; and 10%, coded 5260 (limitation of leg flexion), citing painful and limited motion of a major joint.  Although the VA examination recorded 15 degrees of left knee extension, which supported a 20% rating under code 5261, panel members agreed that the significant decrease in left knee extension represented post-separation worsening and did not accurately reflect the CI’s level of disability at separation.  There was no limitation of flexion that supported a minimum rating under the VASRD diagnostic code for limitation of flexion (5260); and 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).  No additional functional limitation was evidenced by the examinations, and thus there was no higher VASRD §4.71a rating 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 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:

SAF/MRB

Dear XXXXXXXXXX:

		Reference your application submitted under the provisions of DoDI 6040.44 (Section 1554, 10 USC), PDBR Case Number PD-2017-04396.

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.