RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXXXXX  	CASE:  PD-2017-05485
BRANCH OF SERVICE:  Air Force 	SEPARATION DATE:  20061103

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E4, Communications Navigation Journeyman, medically separated for “left knee pain” with a disability rating of 10%.   

CI CONTENTION:  He was given a higher rating by the VA for the left knee condition in 2014and also requested review of additional 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 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 - 20060831	VARD - 20070719	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Left Knee Pain	5299-5259	10%	Chronic Strain Left Knee [Surgical Residuals]	5259	10%	20070425	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  20%	

ANALYSIS SUMMARY:  

Left Knee Pain.  According to the service treatment record (STR) and MEB narrative summary (NARSUM), the CI underwent three left knee surgeries.  These consisted of a meniscectomy, a repeat meniscectomy, and finally a ligament repair and meniscal transplant in November 2004 (12 months before separation).  Post-operative provider and orthopedic specialty notes documented an uncomplicated recovery with restoration of a normal gait and good range of motion (ROM).  There was no STR documentation of persistent effusion, joint impingement (locking), instability, or other VASRD-ratable findings.  There were numerous ROM examinations in evidence (after adequate surgical recovery) that recorded flexion ranging from 115 to 135 degrees (normal 140) and extension of 0 degrees (normal). 

The 5 July 2006 MEB NARSUM examination, 4 months prior to separation, noted complaints of persistent left knee pain aggravated by walking without note of subjective instability or locking.  The NARSUM referred to an orthopedic physical examination consistent with the STR findings elaborated above.  
At the 25 April 2007 VA Compensation and Pension (C&P) examination, 6 months after separation, the CI reported daily left knee pain rated 6/10 that was aggravated by “any weight bearing activities.”  The physical examination recorded a normal gait, and no effusion, instability, or note of tenderness or joint impingement.  Measured ROM was flexion to 120 degrees (after a 10-degree DeLuca deduction) and extension 0 degrees, specifying painful motion. 

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the left knee condition 10%, analogously coded 5299-5259 (cartilage, semilunar removal of, symptomatic), referencing the VASRD.  The VA conferred the same rating under the same code (non-analogous), based on the C&P examination and citing a failure to satisfy criteria for a higher rating.  Code 5259 confers a 10% rating (none higher) for persistent symptoms after meniscectomy independently of any additional criterion.

There was no limitation of motion which supported a rating under the diagnostic codes for limitation of flexion or extension (5260, 5261). There was no history or evidence of dislocated meniscus or loose body causing frequent locking with recurrent effusions (5258) to support a rating under that code. 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 were therefore no criteria in evidence to support a rating higher than 10% 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

Dear XXXXXXXXXXXX:

		Reference your application submitted under the provisions of DoDI 6040.44 (Section 1554, 10 USC), PDBR Case Number PD-2017-05485.

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.