RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXX	CASE:  PD-2013-01504
BRANCH OF SERVICE:  AIR FORCE	BOARD DATE:  20141113
SEPARATION DATE:  20040907

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty SSgt/E-5 (3M0/Services Craftsman) medically separated for a right knee condition.  The condition did not improve adequately to meet the physical requirements of his Air Force Specialty or satisfy physical fitness standards.  He was issued an L4 profile and referred for a Medical Evaluation Board (MEB).  The right knee condition, characterized as “chronic right knee pain due to patellofemoral pain syndrome” was forwarded to the Physical Evaluation Board (PEB) IAW AFI 48-123.  No other conditions were submitted by the MEB.  The Informal PEB found the right knee condition unfitting, and rated at 10%, IAW the Veterans Affairs Schedule for Rating Disabilities (VASRD) guidelines.  The CI made no appeals, and was medically separated.

CI CONTENTION:  “I was not given a final disability rating by the Air Force.  I was rated by the VA for 10%.  It was only for my knees.  I was Honorable Medically Discharged. I also reported migraines, hip pain, back pain.  I wear a knee brace and walk with a cane.  I also qualified for a handicap parking pass by my outside doctors at Straub hospital.  The only medication I am receiving is Naproxen for my knee pain and arthritis.  I purchased a knee brace while incarcerated in prison.  I request a shoe memo which was approved.  I requested a back brace which is still pending in a purchase order.  I reported all problems, I was told because it was brought up before I was discharged, it might not be considered.  Regardless if reported during my entire service or towards the end of my career.  It should be considered.  I’m living with all the pain daily.  Thank you and God Bless.”

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 right knee condition is addressed below.  No other conditions are within the DoDI 6040.44 defined purview of the Board.  Any conditions outside the Board’s scope of review may be eligible for consideration by the Board for Correction of Military Records.

RATING COMPARISON:

Service IPEB – dated 20040609	VA – (12 mos. Post-Separation)	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Right Patellofemoral Pain Syndrome	5003-5299	10%	Patellofemoral Pain Syndrome, Right Knee	5019	0%	20050902	
Other x 0 (Not in Scope)	Other x 1 (Not in Scope)		
Combined:  10%	Combined:  10%	
Derived from VA Rating Decision (VARD) dated 20051118 (most proximate to date of separation)

ANALYSIS SUMMARY:

Knee pain.  This CI has had a long history of knee pain.  He injured his knees in 1998 while doing squats during physical training.  In August 2003, he suffered a re-injury to the right knee while lifting heavy objects during an operational readiness exercise.  Magnetic resonance imaging showed no evidence for internal derangement of the knee.  He was treated with drugs, physical therapy and knee brace.  However, his right knee pain persisted, and an MEB was initiated.  The MEB narrative summary dated 7 May 2004 indicated that he appeared fit and was in no apparent distress.  Physical examination of the right knee revealed some tenderness to palpation with patellar grind.  There was no effusion.  Range-of-motion (ROM) was full.  Tests for ligamentous laxity were negative.  The examiner’s diagnosis was: Chronic right knee pain, due to patellofemoral pain syndrome.

The CI was separated from service in September 2004.  One year later, he had a VA Compensation and Pension exam.  Right knee ROM was normal.  Tests for ligamentous laxity were negative.

The Board carefully reviewed all available evidence and directs attention to its rating recommendation.  The PEB and the VA chose different coding and rating options for the right knee.  The Board determined that the painful right knee condition was essentially non-compensable based on the VASRD §4.71a diagnostic codes for the knee and leg (5256 through 5263).  However; IAW VASRD §4.40 (Functional loss), when part of the musculoskeletal system becomes painful on use, it must be regarded as seriously disabled.  A 10% rating is warranted when there is satisfactory evidence of functional loss due to painful motion of a major joint.  There was no path to a higher rating for the right knee since there was no evidence of ligamentous instability, subluxation or other significantly disabling joint abnormality.  After due deliberation, the Board determined that a disability rating of 10% was appropriate.  Considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the Board found insufficient cause to recommend a change in the PEB adjudication for the chronic unfitting right knee pain.

Other Contended Conditions.  The CI contended that he suffered from migraines, hip pain, and back pain.  As noted above, these conditions were not within the Board’s scope of review.

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 chronic right knee pain, and IAW VASRD §4.40, 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.

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20130913, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans’ Affairs Treatment Record

		
XXXXXXXXXXXXXX
President
Physical Disability Board of Review

SAF/MRB

Dear XXXXXXXXXXXXXX:

Reference your application submitted under the provisions of DoDI 6040.44 (Title 10 U.S.C. § 1554a), PDBR Case Number PD-2013-01504.

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