RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXX	CASE:  PD-2017-05870
BRANCH OF SERVICE:  Air Force	SEPARATION DATE:  20090728

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E5, Health Service Management Journeyman, medically separated for “right knee pain” and “left knee pain,” rated 10% each, with a combined disability rating of 20%.  

CI CONTENTION:  The knee conditions continue to worsen and negatively affect daily activities.  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 - 20090515	VARD - 20100208	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Right Knee Pain	5260-5003	10%	Patellofemoral Syndrome, Right Knee 	5260-5257	10%	20091105	
Left Knee Pain	5260-5003	10%	Patellofemoral Syndrome, Left Knee 	5260-5257	10%	20091105	
COMBINED RATING: 20%	COMBINED RATING OF ALL VA CONDITIONS:  80%	

ANALYSIS SUMMARY:  

Right and Left Knee Pain.  According to the service treatment record and MEB narrative summary (NARSUM), the CI underwent right knee arthroscopic surgery in July 2006, and left knee surgery in February 2008 for patellofemoral syndrome and meniscal injury.  An MRI of the right knee in January 2009 showed no significant pathology.  Both knees were diagnosed with patellofemoral syndrome.  The 23 February 2009 MEB NARSUM examination, 5 months prior to separation, noted complaints of recurrent and chronic bilateral knee pain aggravated by walking.  Physical examination revealed bilateral knee tenderness around the patella with pain noted to the right quadriceps tendon around the right kneecap.  All ligaments were intact bilaterally, and meniscal testing (McMurray’s) was negative.  At the 24 February 2009 physical therapy MEB range of motion (ROM) examination, showed right knee flexion of 100 degrees (normal 140) and extension of 0 degrees (normal) and left knee flexion of 120 degrees and extension of 0 degrees, with painful motion of each knee.  

At the 5 November 2009 VA Compensation and Pension (C&P) examination, 4 months after separation, the CI reported swelling, tenderness, effusion, instability, pain and locking episodes several times a week, with intermittent use of a cane/brace.  X-rays were normal.  Physical examination showed an antalgic gait.  There was bilateral knee crepitus, tenderness and mild instability.  There was no meniscal abnormality.  ROM testing of the left and right knees showed flexion of 140 degrees and extension of 0 degrees with objective evidence of painful motion of each knee on repetition without limitation.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the right and left knee conditions 10% each, dual coded 5260-5003 (limitation of leg flexion due to degenerative arthritis), citing constant pain and inability to perform duties.  The VA also rated the right and left knee conditions 10% each, dual coded 5260-5257 (limitation of leg flexion due to other knee impairment) based on the C&P examination, citing slight recurrent subluxation or lateral instability of each 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) as adjudicated by the PEB.  Alternative 10% meniscal rating under code 5259 was considered, but was of no benefit to the CI as it includes painful motion.  It was agreed that frequent locking due to dislocated semilunar cartilage was not present, and therefore a 20% rating was not justified under the 5258 code for either knee.  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) for either knee.  There was therefore no higher rating than the 10% for each knee adjudicated by the PEB available under any applicable VASRD 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 right or left knee conditions.  

BOARD FINDINGS:  In the matter of the right knee condition and IAW VASRD §4.71, the panel recommends no change in the PEB adjudication.  In the matter of the left knee condition and IAW VASRD §4.71, 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
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-2017-05870.

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.