RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXX	CASE:  PD-2018-00285
BRANCH OF SERVICE:  Air Force 	SEPARATION DATE:  20040528

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E5, Telephone Systems Craftsman, medically separated for “bilateral knee pain secondary to ACL [anterior cruciate ligament] reconstruction,” with a combined disability rating of 20%.

CI CONTENTION:  The CI 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 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 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 - 20040402	VARD - 20041102	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Right Knee, S/P ACL Reconstruction	5257	20%	Right ACL Repair	5257	0%	STR	
Left Knee, S/P ACL Reconstruction	5257	0%	Left ACL Repair	5257	0%	STR	
COMBINED RATING:  20%	COMBINED RATING OF ALL VA CONDITIONS:  0%	

ANALYSIS SUMMARY:

Bilateral Knee Pain:  According to the service treatment record and MEB narrative summary (NARSUM), the CI underwent left knee ACL reconstruction and meniscal repair surgery in June 1998 and right knee ACL reconstruction surgery in 2000.  However, the ACL graft failed and the CI underwent right knee bone grafting in February 2002, and another ACL reconstruction surgery with meniscal repairs in March 2003.  A right knee MRI on 4 February 2004 revealed post-surgical medial femoral condyle chondromalacia and medial tibial plateau and meniscal changes, but the ACL graft was intact.

At the 17 February 2004 orthopedic clinic examination, 3 months prior to separation, the CI reported recurrent right knee swelling and a feeling of shifting and instability.  He denied any locking, catching or giving way symptoms.  The left knee was stable with occasional pain during activity.  Physical examination showed right knee flexion to 120 degrees (normal 140) and extension of 0 degrees (normal).  There was medial joint line and lateral collateral ligament tenderness, but no evidence of meniscal pathology.  The Lachman’s test for instability was 1A (mild instability).  Pivot shift functional instability testing was graded 1-2/3.  There was no evidence of posterior or lateral instability.  The left knee was stable in all planes and ROM was full.  A physical examination on 11 March 2004, 3 months prior to separation, showed a normal gait and “normal right knee flexion and extension. 

The 29 April 2005 MEB NARSUM examination, 1 month prior to separation, noted complaints of continued right knee pain and chronic left knee pain with activity.  Physical examination of the right knee showed a 2A Lachman’s.  There was tenderness along the medial and lateral femoral condyles, with no meniscal signs and minimal crepitus with ROM.  The left knee was stable (1A Lachman).  Bilateral knee ROM was 0-120 degrees.  There was no VA examination proximate to separation in evidence.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the right knee 20% and left knee 0%, both coded 5257 (recurrent subluxation or lateral instability).  The VA rated the right and left knee conditions 0%, coded 5257, because the CI did not attend the C&P examination.  

Right Knee.  There was evidence of slight residual instability to support a 10% rating under code 5257.  The panel also agreed that an additional 10% rating was warranted for pain after meniscal surgery (5259) or alternatively for painful motion (5003).  Panel members considered other knee and analogous codes, but all were less applicable or not advantageous to rating.  The panel’s rating recommendation for the right knee of 10% for residual instability and 10% for painful motion provides no ratings benefit to the CI, and therefore no change to the PEB’s right knee rating is recommended.  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.  

Left Knee.  There was no limitation of flexion or extension of the left knee that supported a rating for limitation of motion (5260, 5261) and there was no evidence of residual functional instability of the left knee for rating under 5257.  However, there was evidence of persistent pain following meniscal surgery to support a 10% rating under code 5259.  The panel considered other knee and analogous codes, but all were less applicable or not advantageous to rating.  After due deliberation, considering all the evidence and mindful of VASRD §4.3 (reasonable doubt), the panel recommends a disability rating of 10% for the left knee condition.  

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 left knee condition, the panel recommends a disability rating of 10%, coded 5259, IAW VASRD §4.71a.  

The panel recommends the CI’s prior determination be modified as follows; and, that the discharge with severance pay be re-characterized to reflect permanent disability retirement, effective the date of medical separation:  

CONDITION	VASRD CODE	PERMANENT RATING	
Right Knee Pain Secondary to ACL Reconstruction Surgery	5257	20%	
Left Knee Pain Secondary to ACL Reconstruction Surgery	5259	10%	
COMBINED	30%	

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

Dear XXXXXXXX:

		Reference your application submitted under the provisions of DoDI 6040.44 (Section 1554, 10 USC), PDBR Case Number PD-2018-00285.

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 not in accordance with the guidelines of the Veterans Affairs Schedule for Rating Disabilities.  Accordingly, the Board recommended your separation be re-characterized to reflect disability retirement, rather than separation with severance pay.

I have carefully reviewed the evidence of record and the recommendation of the Board.    I concur with that finding, accept the recommendation and determined that your records should be corrected accordingly.  The office responsible for making the correction will inform you when your records have been changed.

As a result of the aforementioned correction, you are entitled by law to elect coverage under the Survivor Benefit Plan (SBP).  Upon receipt of this letter, you must contact the Air Force Personnel Center at (210) 565-2273 to make arrangements to obtain an SBP briefing prior to rendering an election.  If a valid election is not received within 90 days from the date of this letter, you will not be enrolled in the SBP program unless at the time of your separation, you were married, in such a case, failure to render an election will result in automatic enrollment by law.