RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXX		CASE:  PD-2012-01177
BRANCH OF SERVICE:  AIR FORCE		BOARD DATE:  20140207
SEPARATION DATE:  20020917

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an Air National Guard TSGT/E-6 (3S111/Military Equal Opportunity
and Treatment Craftsman) serving in an Active Guard and Reserve (AGR) status, with over 8 years of active duty, medically separated for residual left knee instability status post (s/p) anterior cruciate ligament (ACL) repair  (1998) associated with chondromalacia.  The CI first injured her left knee in 1988.  Over the next few years, she was treated conservatively as well as by arthroscopy.  Despite treatment, the left knee condition could not be adequately rehabilitated to meet the physical requirements of her Air Force Specialty or satisfy physical fitness standards.  She took a leave of absence from her AGR duties and was referred for a Medical Evaluation Board (MEB).  The MEB forwarded residual knee instability and chondromalacia to the Physical Evaluation Board (PEB) IAW AFI 48-123.  No other conditions were submitted by the MEB.  The Informal PEB adjudicated the residual left knee instability s/p ACL repair (1998) associated with chondromalacia condition as unfitting, rated 10% citing criteria DoD and the Veterans Affairs Schedule for Rating Disabilities (VASRD) guidelines.  The CI made no appeals and was medically separated.

CI CONTENTION:  “Since the original rating, my condition has continued to deteriorate to the point that in the past 6-8 months, I have fallen down stairs.  My primary Care Doctors has ordered me a cane to use to assist with walking, and to cut down on the times I fall, whether it be on stairs, or just walking.  Back approximately 2006/2007 timeframe, I had the 3-shot Synvisc shots given to me in my left knee.  I again in Oct 2011 had the single shot Synvisc, which did more harm the help because it aggravated the knee.  Currently I am seeing Dr. Mark Kircher, and he has ordered the 3-shot Synvisc to be given to me again on 6/8, 15, 22/2012.  As time goes on my knee pain continues to hamper me and my ability to lead a normal life.  I don't feel that any person should have to endure the pain and agony that accompanies me on a daily basis, just doing the small menial tasks around the house.  Mowing my lawn is an all-day affair because I have to stop and rest because my knee is throbbing, just from walking behind the lawn mower, and mowing my yard.  I have excruciating pain walking up stairs, so there for, if there is not an elevator in the building, it take me extra time to go up the stairs to get where I need to go. (this is a prime example of my home, bedrooms are on the second floor.  We do not have an elevator in our house).  I have sharp shooting pains if l get up and try to move to quickly, or if l switch directions my leg will give out. All of these common everyday things, that cause me to have difficulties with everyday living.”

SCOPE OF REVIEW: The Board’s scope of review is defined in DoDI 6040.44, Enclosure 3, paragraph 5.e.(2).  It is limited to those conditions determined by the PEB to be unfitting for continued military service and those conditions identified but not determined to be unfitting by the PEB when specifically requested by the CI.  The rating for the unfitting left knee condition is addressed below; no additional conditions are within the Board’s defined DoDI 6040.44 purview.  Any conditions or contention not requested in this application, or otherwise outside the Board’s defined scope of review, remain eligible for future consideration by the Board for Correction of Military Records.
The Board acknowledges the impairment with which the CI’s service-connected condition continues to burden her, but notes the Disability Evaluation System (DES) has neither the role nor the authority to compensate members for anticipated future severity or potential complications of conditions resulting in medical separation.  That role and authority is granted by Congress to the Department of Veterans Affairs, operating under a different set of laws.

RATING COMPARISON:

Service IPEB – Dated 20020823 | VA - (Exam ~ 1 Mo. Pre-Separation)
Condition | Code | Rating | Condition | Code | Rating | Exam
Residual L Knee Instability S/P ACL Repair (1998) Associated w/ Chondromalacia | 5257 | 10% | DJD of the L Knee | 5259 | 10% | 20020823
No Additional MEB/PEB Entries | Other x 7 | 20020823
Combined:  10% | Combined:  30%
Derived from VA Rating Decision (VARD) dated 20021021 (most proximate to date of separation [DOS]).

ANALYSIS SUMMARY:

Left Knee Condition.  As noted above, the CI injured her left knee in 1988 and was managed conservatively and by arthroscopy.  The records for the latter procedure are not in evidence.  On 15 February 2001, she had repeat arthroscopy for a torn medial meniscus of the left knee as seen on magnetic resonance imaging.  At surgery, she was noted to have an intact ACL and lateral meniscus.  She did have a small patellar plica (redundant synovial tissue), chondromalacia (degeneration of the cartilage) and a torn medial meniscus.  The meniscus and chondromalacia were repaired.  The remainder of the operative report was not in evidence.  Efforts to obtain the missing records were not successful.  The narrative summary was dated 16 July 2002, two months prior to separation.  The CI reported limited function of her left leg and that it was unstable with difficulty with stairs and walking.  The examiner noted that her height was 66 inches and weight was 199 pounds.  She had some laxity of the left knee (not further specified) and limited range-of-motion (ROM) with pain, again not further specified.  At the VA Compensation and Pension (C&P) examination performed on 23 August 2002, the CI reported that she used two separate braces, a “pull-on” and an “articulated” one.  Neither locking nor laxity was reported, but she did endorse “giving way.”  On examination, the knees were of equal circumference without effusion.  The medial and lateral collateral ligaments were stable; slight laxity was noted on the ACL.  The ROM of the left and right knee was normal, but with slight clicking on the left.  However, at a second C&P examination on 25 October 2004, there was no ligamentous instability and testing of the ACL was normal.  The ROM was reduced equally bilaterally secondary to body habitus.

The Board directs attention to its rating recommendation based on the above evidence.  The PEB rated the left knee for residual instability at 10% using the code 5257, other impairment of the knee.  The VA also rated the kneed at 10%, but used the coding option 5259, removal of the meniscus; this was later changed to 5010-5260, traumatic arthritis and limitation of flexion, at the 2004 rating decision, but kept at a 10% disability rating.  The Board considered the findings and noted that the ROM was normal on the VA examination.  She had painful motion and a partial meniscectomy.  While the ACL was noted to be lax on the 2002 C&P, it was normal on the 2004 examination.  The Board considered the different coding options available and found no route to a rating higher than the 10% adjudicated by both the PEB and VA.  While the Board determined that the 5259 code utilized by the VA was more accurate, it does not recommend a change if there no advantage to the CI.  After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the Board concluded that there was insufficient cause to recommend a change in the PEB adjudication for the back condition.

BOARD FINDINGS:  IAW DoDI 6040.44, provisions of DoD or Military Department regulations or guidelines relied upon by the PEB will not be considered by the Board to the extent they were inconsistent with the VASRD in effect at the time of the adjudication.  The Board did not surmise from the record or PEB ruling in this case that any prerogatives outside the VASRD were exercised.  In the matter of the knee condition and IAW VASRD §4.71a, the Board unanimously recommends no change in the PEB adjudication.  There were no other conditions within the Board’s scope of review for consideration.

RECOMMENDATION:  The Board, therefore, recommends that there be no re-characterization of the CI’s disability and separation determination, as follows:

UNFITTING CONDITION | VASRD CODE | RATING
Residual Left Knee Instability s/p ACL repair associated with chondromalacia | 5257 | 10%
COMBINED | 10%

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20120607, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans’ Affairs Treatment Record

XXXXXXXXXXXXXX
President
Physical Disability Board of Review

SAF/MRB

XXXXXXXXXXXXXX

Dear XXXXXXXXXXXXXX:

	Reference your application submitted under the provisions of DoDI 6040.44 (Title 10 U.S.C. §  1554a), PDBR Case Number PD-2012-01177.

	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.

							Sincerely,

XXXXXXXXXXXXXX
Director
Air Force Review Boards Agency

Attachment:
Record of Proceedings

PD-2012-01177