RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME: XXXXXXXXXX	CASE:  PD-2017-06132
BRANCH OF SERVICE:  Air Force 	SEPARATION DATE:  20080308

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E6, Avionics Test Station & Components Craftsman, medically separated for “left knee pain due to chondromalacia, status post [s/p] ACL [anterior cruciate ligament] repair” and “low back pain post microdiscectomy at L5,” rated 10% each, with a combined disability rating of 20%.  

CI CONTENTION:  Review requested of unfitting left knee and other 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 PEB to be unfitting for continued military service, and when specifically requested by the CI, those conditions identified by the 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 - 20080125	VARD - 20080820	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Left Knee Pain… 	5003	10%	Left Knee, S/P Anterior Cruciate Ligament Repair and Meniscectomy	5259	10%	20080507	
Low Back Pain… 	5243	10% 	Degenerative Disc Disease, Lumbar Spine	5243	10%	20080507	
Migraines	Not Unfitting	Migraine Headaches	8100	0%	20080507	
COMBINED RATING:  20%	COMBINED RATING OF ALL VA CONDITIONS:  50% 	

ANALYSIS SUMMARY:  

Left Knee Pain.  According to the service treatment record (STR) and MEB narrative summary (NARSUM), the CI tore her ACL and medial meniscus in May 2001 while playing softball, and underwent an ACL repair in July 2002 followed by a month of physical therapy (PT).   After re-injuring the knee while running in September 2003, she had an arthroscopic procedure in June 2004 resulting in diagnoses of a medial femoral condyle micro-fracture, medial plica syndrome, and grade 3-4 trochlea and patella chondromalacia.  She had no improvement after 2 months of PT, and underwent a partial medial meniscectomy with debridement on 8 November 2006. 

The 7 September 2007 MEB NARSUM, 6 months prior to separation, noted the CI had no improvement in pain since the last surgery, and was unable to run.  Physical examination revealed medial and inferior joint line tenderness, but no swelling, induration, edema, erythema, warmth, deformity, crepitus or patellofemoral lateral tracking.  McMurray’s testing (for meniscal tear) was positive, but laxity and anterior drawer signs were negative.  Left knee ROM was reported as “abnormal” with slightly decreased flexion, but no pain elicited by knee motion.  Neurological, sensation and motor strength tests were normal.  The examiner noted that an orthopedic consult indicated no further remaining treatment options and diagnosed “left knee ACL tear, s/p ACL repair with multiple meniscal and cartilaginous defects.”

At the 7 May 2008 Compensation and Pension (C&P) examination, 2 months after separation, the CI complained of progressively worsening left knee pain which limited her ability to climb stairs.  She was able to stand for more than 1 but less than 3 hours, and could walk more than ¼ mile but less than a mile. She reported the left knee would give way but with episodes of subluxation or need for an assistive device for ambulation.  Physical examination showed left knee ROM from 0-115 degrees (normal 0-140) with pain and tenderness present, but no effusion or dislocation.  McMurray’s testing was negative and a meniscal abnormality was not recorded.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the left knee condition 10%, coded 5003 (degenerative arthritis).  The VA also rated the left knee condition 10%, but coded 5259 (cartilage, semilunar, removal of, symptomatic), citing symptomatic removal of the semilunar cartilage.  Panel members agreed there was no limitation of flexion or extension (5260 or 5261) which supported a compensable rating, but there was persistent pain after meniscal surgery warranting a 10% rating under code 5259.  There was no history or evidence of dislocated meniscus or loose body causing frequent locking with recurrent effusions (5258), and 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 left knee condition.

Chronic Low Back Pain (LBP).  According to the STR and VA treatment records, the CI’s low back condition began sometime in 1998 with no specific injury or trauma.  She was initially treated for a muscle strain and then underwent a micro-discectomy (L2) in 2003.  The back condition was determined to be an additional unfitting condition by the formal PEB; it was not identified by the MEB and therefore no NARSUM or formal examination was conducted.    

At the 21 May 2008 C&P examination, 2 months after separation, the CI reported her back condition had gotten progressively worse since onset, and following the 2003 micro-discectomy, she began experiencing “tingles” down her back and the left lower extremity to the fifth toe.  She also had some numbness and paresthesia.   Physical examination showed normal posture, but an antalgic gait with no spasms or lumbar flattening, lordosis or scoliosis.  Thoracolumbar flexion was to 80 (normal 90), extension to 20 degrees extension (normal 30), right and left lateral flexion to 30 degrees (normal) and right rotation (no left rotation measurement) to 30 degrees (normal).  The incomplete combined ROM was at least 190 degrees.

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the low back condition 10%, coded 5243 (intervertebral disc syndrome), citing chronic pain, tenderness, and functional loss.  The VA also rated the low back condition 10%, coded 5243, based on the C&P examination 2 months after separation, citing limitation of motion.  Panel members agreed that a 10% rating, but no higher, was justified for limitation of flexion (greater than 60 degrees but not greater than 85 degrees).  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 evidence of intervertebral disc syndrome) which resulted in incapacitating episodes requiring physician-prescribed bed rest to warrant consideration of rating under that alternate 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 low back condition.

Contended PEB Condition:  Migraines.  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 or implicated in the commander’s statement, and did not 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 left knee condition and IAW VASRD §4.71a, the panel recommends no change in the PEB adjudication.  In the matter of the low back condition and IAW VASRD §4.71a, the panel recommends no change in the PEB adjudication.  In the matter of the contended migraines, 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 

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-2017-06132.

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.