RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  xxxxxxxxxxxxxxxxxxxxxX	CASE:  PD-2017-05456
BRANCH OF SERVICE:  Air Force	SEPARATION DATE:  20070416

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E2, Basic Trainee, medically separated for “anterior 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 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 - 20070927	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Anterior Knee Pain	5099-5003	10%	Left Knee Sprain	5260	10%	20070703	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  30%	

ANALYSIS SUMMARY:  

Anterior (Left) Knee Pain.  According to the service treatment record and MEB narrative summary (NARSUM), the CI’s knee condition began in January 2007 after falling from an obstacle, injuring her left knee. Initial X-ray and MRI noted a small effusion with minimal pre-patellar edema and healing dorsal defect of the patella.  At the primary care clinic appointment of 5 February 2007, 2 months prior to separation, the physical examination noted normal knee appearance with tenderness.  Range of motion (ROM) was normal, with no pain elicited and no muscle weakness noted.  X-ray on 13 February 2007 was negative and showed a previous small joint effusion had resolved.  

The MEB NARSUM examination 9 days later, noted complaints of continued left knee pain and impaired mobility.  Physical examination referenced an orthopedics appointment from 13 February 2007 that recommended the MEB.  The examiner noted swelling, especially of the supra patellar burse.  The patellofemoral region was tender and active flexion was 70 degrees (normal 140) with 0 degrees of extension (normal), with pain noted at the extreme limits of ROM.  A patellar grind test was noted as positive.  There was crepitus, and muscle tone was abnormal with atrophy noted.  

At the 3 July 2007 VA Compensation and Pension (C&P) examination, 3 months after separation, the CI reported burning, aching, oppressing, and sharp pain, rated at 4/10.  The pain was elicited by physical activity and also came on without action.  It was relieved by rest and medication.  Functional impairment was no kneeling, squatting, prolonged standing or walking, and limited stairs.  The CI stated the condition did not cause incapacitation and was not receiving any treatment.  Physical examination showed an antalgic gait on the left.  Examination of the feet did not reveal signs of abnormal weight bearing and the CI did not require an assistive device for ambulation.  There were signs of tenderness and guarding of movement, but no signs of edema, effusion, weakness, redness, heat, abnormal movement, and subluxation.  ROM was 85 degrees flexion with pain with normal extension.  Flexion was additionally limited 10 degrees by pain after repetitive use.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the knee condition 10%, analogously coded 5003 (degenerative arthritis).  The VA rated the left knee sprain 10%, coded 5260 (leg, limitation of flexion), based on the C&P examination, citing painful and limited motion.  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 panel considered other VASRD knee and analogous codes, but all were less applicable and/or not advantageous for rating.  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 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.  

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

Dear XXXXXXXXXXXXX:

		Reference your application submitted under the provisions of DoDI 6040.44 (Section 1554, 10 USC), PDBR Case Number PD-2017-05456.

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.