RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  xxxxxxxxxx	CASE:  PD-2021-00099
BRANCH OF SERVICE:  Air Force 	SEPARATION DATE:  20080602

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

CI CONTENTION:  The rating for his right knee should have been higher.  He also requested review of additional conditions not identified by the Medical Evaluation Board (MEB) and/or 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 - 20080411	VARD - 20080822	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Right Knee Pain	5099-5003	10%	Status Post (S/P) Right Knee Patella Dislocation Surgery with Scars	5260	10%	20080703	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  10%	

ANALYSIS SUMMARY:  

Right Knee Pain.  According to service treatment records (STR) and MEB narrative summary (NARSUM), the CI underwent right knee medial patellofemoral ligament reconstruction in October 2005.  Radiographic findings in January 2008 showed no significant bony pathology.  

At an orthopedic visit on 17 January 2008, the CI reported continued anterior knee pain, which was minimal at rest, but increased by activity.  The pain was exacerbated by stairs, squatting, and sitting for prolonged periods with the knee flexed.  He denied radiating pain and swelling, and only experienced occasional crepitus.  Physical examination noted normal gait with slight external rotation of the lower leg.  Right knee active range of motion (ROM) was from 0-120 degrees (normal 0-140).  The examiner noted tenderness and positive patellar grind, but negative Lachman’s, anterior drawer, and McMurray’s tests.  
The 12 February 2008 MEB NARSUM examination, 4 months prior to separation, noted CI complaints of continued anterior right knee pain, worsened by activity, climbing stairs and squatting.  He denied any instability and stated he usually had no pain at rest.  Physical findings showed ROM from 0-120 degrees, with some pain during hyperflexion.  There was no medial lateral instability, and Lachman and drawer tests were negative.   

At the 3 July 2008 VA Compensation and Pension (C&P) examination, 1 month after separation, the CI reported right knee pain described as constant, sharp, aching, and cramping in nature.  He rated this pain at 6/10 and noted that it was elicited by physical activity.  He denied stiffness, swelling, heat, redness or giving way and locking.  Physical examination showed normal gait and posture, and no instability.  The examiner noted tenderness and recorded ROM from 0-140 degrees.  Right knee X-rays were within normal limits.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the right knee condition 10%, analogously coded 5099-5003 (arthritis, degenerative), citing right knee pain that existed prior to service with service aggravation.  The VA rated the right knee condition 10%, coded 5260 (leg, limitation of flexion), based on the C&P examination, citing right knee tenderness.  While there was no compensable limitation flexion or extension under codes 5260 or 5261, there was evidence of painful motion with functional loss supporting a 10% rating (based on §4.59, §4.40 and §4.45).  Diagnostic code 5259 (cartilage, semilunar, removal of, symptomatic) was applicable in this case, but the maximum 10% rating under that code provided no benefit to the CI.  The panel considered other VASRD knee and analogous codes, but all were less applicable and not advantageous for rating. There was therefore no higher rating than the 10% adjudicated by the PEB.  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.  

BOARD FINDINGS:  In the matter of the right 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.

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20210916, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Record 

SAF/MRB
3351 CELMERS LANE
JBA NAF WASHINGTON, MD 20762-6435

Dear XXXXXXXXXX:

	Reference your application submitted under the provisions of DoDI 6040.44 (Section 1554, 10 USC), PDBR Case Number PD-2021-00099.

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.

						Sincerely,