RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXX	CASE:  PD-2017-04711
BRANCH OF SERVICE:  Air Force 	SEPARATION DATE:  20070529

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

CI CONTENTION:  Review of all conditions 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 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 - 20070409	VARD - 20080409	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Right Knee Pain…	5003	10%	Right Knee Pain…	5260	10%	20070808	
Migraine Headaches	Cat II	Tension Headaches	8100	0%		
Allergic Rhinitis	Cat II	Seasonal Rhinitis…	6522	0%		
Adjustment Disorder…	Cat III	PTSD with Cognitive Disorder	9411	50%	20070905	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  60%	

ANALYSIS SUMMARY:  

Chronic Right Knee Pain.  According to the service treatment record and MEB narrative summary (NARSUM), the CI underwent right knee surgery in April 2005 for a medial meniscus near-total debridement and lateral meniscus repair.  He developed a deep vein thrombosis postoperatively that was successfully treated with anticoagulant medication for approximately 2 months.  A subsequent surgical procedure on his knee was performed in March 2006 when he underwent an allograft meniscal replacement of the medial meniscus.  At an orthopedic visit on 22 June 2006, his range of motion (ROM) was 0-120 degrees (normal 0-140) without problems.  He had minimal tenderness on his knee, but had no locking, no swelling, and no significant symptoms of meniscal pathology.  The CI returned to duty on 20 July 2006.  An MRI on 6 September 2006 showed interval progression of the degenerative appearance of the attachment of the meniscal allograft with fraying and small tears.  

The 17 November 2006 MEB NARSUM examination, 6 months prior to separation, noted complaint of significant knee pain which limited his activities.  Physical examination showed a well-healed surgical incision with some tenderness along his medial joint line and some very mild crepitus (grinding sensation).  On examination, the right knee ROM following repetitive movement was flexion of 120 degrees and extension of 0 degrees.  The examiner noted the CI had a ligamentous stable knee to anterior, posterior, medial, and lateral rotational stresses.  There was no decreased sensation in the leg.  A MEB NARSUM dated 11 January 2007 referred to the prior NARSUM and noted the CI would likely continue to have pain with subsequent duty restrictions and would be unable to deploy.  A note dated the next day indicated a 4T profile was still warranted.  

At an orthopedic clinic visit on 27 March 2007, 2 months prior to separation, he underwent evaluation for the knee pain and had a second opinion about long term expectations.  Physical examination showed no swelling, but some mild tenderness along the medial joint line was noted along with a slight varus position of the knee.  Instability (Lachman's and anterior/posterior drawer tests) and laxity testing (varus and valgus stress tests) were all negative.  There was mild patellofemoral crepitus, but the patellar tendon tracked straight.  There was “full extension and good flexion.”  X-rays showed a decrease in the medial joint space with subchondral sclerosis, which the examiner felt was probably the primary source of the CI’s pain due to the abnormal stresses involved.  No further surgery was recommended, but non-impact type exercise was recommended.  At the pain management clinic visit on 11 April 2007, Lortab (a narcotic) was continued for the knee pain.  

At the 8 August 2007 VA Compensation and Pension (C&P) examination, 2 months after separation, the CI reported continued right knee pain.  Physical examination showed the CI had right knee pain when walking on his toes and heels.  The right knee ROM following repetitive movement was flexion of 110 degrees and extension of 0 degrees with painful motion.  There were no signs of any swelling or tenderness in the right leg.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the right knee condition 10%, coded 5003 (degenerative arthritis).  The VA also rated the right knee condition 10%, coded 5260 (leg, limitation of flexion), based on the C&P examination, citing painful, limited motion of the knee.  There was no limitation of motion which supported a rating under the diagnostic codes for limitation of flexion or extension (5260, 5261).  However, there was evidence of painful motion with functional loss supporting a 10% rating (based on §§4.59, 4.40 and 4.45).  The examinations proximate to separation did not demonstrate the presence of ligamentous instability or laxity (5257), and there was no history of dislocated meniscus or loose body causing frequent locking with recurrent effusions (5258) to support a rating under the respective codes.  The 5259 code (cartilage, semilunar, removal of, symptomatic) was applicable in this case but the maximum 10% rating under that code provided no benefit to the CI.  There was 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).  There was therefore 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 knee condition.  

Contended PEB Conditions:  Migraine Headaches, Allergic Rhinitis, and Adjustment Disorder.  The panel’s main charge is to assess the fairness of the PEB determination that the contended conditions were not unfitting.  The headaches and allergic rhinitis were neither profiled nor implicated in the commander’s statement, and did not fail retention standards.  The panel found no performance-based evidence from the record that any of the conditions significantly interfered with satisfactory duty performance at separation.  Adjustment disorder is not a condition constituting a disability IAW DoDI 1332.38.  After due deliberation, the panel concluded there was insufficient cause to recommend a change in the PEB fitness determination for any of the contended conditions, so no additional disability ratings are recommended.  

BOARD FINDINGS: In the matter of the right knee condition and IAW VASRD §4.71a, the panel recommends no change in the PEB adjudication.  In the matter of the contended migraine headaches, allergic rhinitis, and adjustment disorder, the panel recommends no change from the PEB determinations as not unfitting.  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:  

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Dear XXXXXXXXXX:

		Reference your application submitted under the provisions of DoDI 6040.44 (Section 1554, 10 USC), PDBR Case Number PD-2017-04711.

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.