SAF/MRB
1500 West Perimeter Road, Suite 3700
Joint Base Andrews, MD 20762

Dear XXXXXXXXXX:

		Reference your application submitted under the provisions of DoDI 6040.44 (Section 1554, 10 USC), PDBR Case Number PD-2017-05104.

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.

					

RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXX 	CASE:  PD-2017-05104
BRANCH OF SERVICE:  Air Force 	SEPARATION DATE:  20070220

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E5, Aerospace Ground Equipment Craftsman, medically separated for “right knee pain” and “chronic low back pain,” rated 10% each, with a combined  disability rating of 20%.  

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 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 - 20061214	VARD - 20080107	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Right Knee Pain	5099-5003	10%	S/P Meniscal Repair, Right Knee	5258	0%	20071207	
Chronic Low Back Pain	5237	10%	Lumbago	5299-5237	10%	20071207	
Right Shoulder Pain	Cat II	Status Post Right Shoulder	5299-5201	NSC	20071207	
COMBINED RATING:  20%	COMBINED RATING OF ALL VA CONDITIONS:  10%	

ANALYSIS SUMMARY:  

Right Knee Pain.  According to the service treatment record (STR) and MEB narrative summary (NARSUM), the CI underwent right knee surgery in September 2005 for a medial meniscal tear.  He had a revision of the medial meniscal tear done in December 2005 where a great deal of scar tissue was removed.  At the time of the orthopedic clinic appointment on 15 August 2006, 6 months prior to separation, the CI reported chronic right knee pain.  On examination there was tenderness over the medial and posteromedial joint lines and in the proximal patellar tendon. McMurray’s test was negative, though he did have some discomfort on the medial aspect of the knee.  Right knee range of motion (ROM) testing showed flexion of 135 degrees (normal 140) and extension of 0 degrees (normal).  The 26 September 2006 MEB NARSUM examination, 5 months prior to separation, noted complaints of right knee pain.  Physical examination showed no swelling, tenderness, patellar grind or crepitus.  McMurray’s and Lachman’s tests were negative and there was no pain with varus or valgus stress test.  Right knee ROM testing showed full ROM without pain. 

At the 7 December 2007 VA Compensation and Pension (C&P) examination, 10 months after separation, the CI reported sharp constant right knee pain (6-7/10).  Occasionally he had flare-ups 2 to 3 times a day.  He stated the flare-ups arose with working more than 30 minutes and also with prolonged standing.  He related a locking sensation when he slept at night.   Anterior and posterior drawer, Lachman’s and green testing were negative and there was no medial or lateral joint line tenderness.  The McMurray’s test was slightly painful but considered to be negative.  Right knee ROM testing showed flexion of 140 degrees and extension of 0 degrees.  X-rays were normal.

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the right knee condition 10%, analogously coded 5003 (arthritis, degenerative).  The VA rated the right knee condition 0%, coded 5258 (cartilage, semilunar, dislocated, with frequent episodes of “locking,” pain, and effusion into the joint), based on the VA C&P examination, citing no evidence of dislocated semilunar cartilage causing frequent episodes of locking, pain and effusion into the joint.  

There was no history or evidence of dislocated meniscus or loose body causing frequent locking with recurrent effusions (5258).  However, the persistence of pain after meniscal surgery warranted a 10% rating under the 5259 code (cartilage, semilunar, removal of symptomatic).  There was no fracture, nonunion or mal union 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 concluded there was insufficient cause to recommend a change in the PEB adjudication for the right knee condition.  

Chronic Low Back Pain.  According to the STR and MEB NARSUM, the CI’s back condition began in April 2006 after knee surgery.  However, there was no history of trauma or injury.   The MEB NARSUM examination, 5 months prior to separation, noted low back pain that limited the CI from doing sit-ups and heavy lifting.  Physical examination showed a normal gait, but there was tenderness.  Strength and reflexes were normal in the lower extremities and straight leg testing was negative.  At the time of the physical therapy (PT) ROM evaluation on 3 November 2006, 4 months prior to separation, the CI reported 3/10 low back pain.  On examination, thoracolumbar ROM testing showed flexion of 65 degrees (normal 90) and extension of 15 degrees (normal 30).  

During the C&P examination, 10 months after separation, the CI reported complaints of 5-6/10 low back pain aggravated by prolonged sitting and bending.  Pain was localized in the lumbar area and he denied having significant flare-ups.  There was no associated radiation of pain and no weakness or numbness.  Physical examination showed good posture and normal gait.  The back was bilaterally symmetric without gross deformity or apparent congenital scoliosis.  There was no exaggerated thoracic kyphosis or lumbar lordosis.  Reflexes were +1, strength was normal and straight leg raise testing was negative without objective findings of radiculopathy or polyneuropathy.  Thoracolumbar ROM after repetition showed flexion of 70 degrees and combined ROM of 210 degrees (normal 240).  Flexion was limited by para spinal muscle spasms.   X-rays demonstrated minimal narrowing of the L5-S1 disc space.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the back condition 10%, coded 5237 (lumbosacral strain).  The VA also rated the back condition 10%, analogously coded 5237, based on the VA C&P examination, citing forward flexion to 70 degrees limited by para spinal muscle spasms.  The panel agreed that a 10% rating, but no higher, was justified for limitation of flexion (greater than 60 degrees but not greater than 85 degrees) as reported on the PT and C&P examinations proximate to separation.  There was no muscle spasm or guarding severe enough to result in an abnormal gait or spinal contour, thus the next higher 20% rating was not justified on this basis.  There was no documentation of intervertebral disc syndrome with incapacitating episodes which would provide for a higher rating under that formula.  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 back condition.  

Right Shoulder Pain.  The panel’s main charge is to assess the fairness of the PEB determination that the contended condition was not unfitting.  The contended condition was not profiled, implicated in the commander’s statement or judged to fail retention standards.  There was no performance-based evidence from the record that the condition significantly interfered with satisfactory duty performance at separation.  After due deliberation, the panel concluded there was insufficient cause to recommend a change in the PEB fitness determination for the contended condition, so no additional disability rating is 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 back condition and IAW VASRD §4.71a, the panel recommends no change in the PEB adjudication.  In the matter of the contended right shoulder condition, the panel recommends no change from the PEB determination 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.