RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXX	CASE:  PD-2013-01806
BRANCH OF SERVICE:  AIR FORCE	BOARD DATE:  20140701
SEPARATION DATE:  20050919

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty A1C/E-3 (4N051/Aerospace Medical Services Journeyman) medically separated for a left knee condition.  He was issued a permanent L4 profile and referred for a Medical Evaluation Board (MEB).  Chronic left knee pain status post left lateral partial meniscectomy was forwarded to the Physical Evaluation Board (PEB) IAW AFI 48-123 no other conditions were submitted by the MEB.  The Informal PEB (IPEB) adjudicated chronic left knee pain status post left lateral partial meniscectomy as unfitting, rated 10%, with application of the VA Schedule for Rating Disabilities (VASRD).  The remaining condition was determined to be not unfitting.  The CI made no appeals, and was medically separated.

CI CONTENTION:  “Chronic degeneration of the injured knee and lumbar spine”

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.  The not unfitting color deficient condition was not contended; and, thus is not within the DoDI 6040.44 defined purview of the Board.  The above stated and any other condition or contention not requested in this application, remain eligible for future consideration by the Board for Correction of Military Records.  Also, the Board acknowledges the CI’s contention that suggests a rating should have been conferred for another condition documented at the time of separation.  The Board wishes to clarify that it is subject to the same laws for disability entitlements as those under which the Disability Evaluation System (DES) operates.  While the DES considers all of the member's medical conditions, compensation can only be offered for those medical conditions that cut short a member’s career, and then only to the degree of severity present at the time of final disposition.  However the Department of Veterans Affairs, operating under a different set of laws (Title 38, United States Code), is empowered to compensate all service connected conditions and to periodically re-evaluate said conditions for the purpose of adjusting the Veteran’s disability rating should his degree of impairment vary over time.

RATING COMPARISON:

Service IPEB – Dated 20050802	VA* - (2.3 Mos. Post-Separation)	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Left Knee Pain	5259	10%	Status Post Partial Left Lateral Meniscectomy	5260	0%	20051128	
Other x 1 (Not in Scope)	Other x 1 (Not in Scope)	20051128	
Combined:  10%	Combined:  0%	
*Derived from VA Rating Decision (VARD) dated 20051213 (most proximate to date of separation

ANALYSIS SUMMARY:

Chronic Left Knee Pain:  The CI had a long history of chronic left knee pain.  The CI reported knee pain since age 17 attributable to multiple hockey and football injuries.  The pain worsened in technical training school in September 2003.  He did not respond to conservative therapies.  A magnetic resonance imaging on 30 June 2004 revealed a minimal popliteal cyst and a small apical tear of the body of the lateral meniscus.  On 18 January 2005, the CI underwent an arthroscopic partial lateral meniscectomy and excision of synovial plica of the left knee.  He continued to have pain, swelling, and loss of range-of-motion (ROM), especially while participating in physical activities.  He was limited from physical strain in his military duties.  During a physical therapy functional assessment consultation on 13 June 2005, 3 months prior to separation, the CI reported left knee pain with walking, steps, squats, and improved with non-steroidal anti-inflammatory medications.  The CI complained of popping in the left knee, instability, and “gives out” after rising from a chair, and knee locking up.  Physical examination revealed positive Frund’s test of patellar tenderness, pain with tibial rotation and distraction (Apley’s test), inability to squat past 30 degrees due to pain, and ROM of 105 degrees of flexion.  The examiner found the examination was indicative of mild disability because the CI could not squat, and had a gait deficit on stairs.  At the MEB narrative summary examination, performed on 18 July 2005, approximately 2 months before separation, found a normal gait, with mild effusion of the left knee, crepitus, with painful and decreased ROM due to pain and mild swelling.  There were negative anterior and posterior drawer signs for cruciate ligament stability, negative Lachman’s test for anterior cruciate ligament stability, and no ecchymosis.  There was no compensation and pension (C&P) exam in evidence.  The C&P examination cited in the VA rating decision was performed on 28 November 2005, approximately 2 months after separation.  The CI reported he had recurrent pain and swelling of the left knee particularly when climbing steps.  He was able to walk indefinitely.  Physical examination showed no abnormality of the knee and ROM of the left knee from zero to 150 degrees, without additional limitations with repetitive use.  The goniometric ROM evaluations in evidence which the Board weighed in arriving at its rating recommendation, with documentation of additional ratable criteria, are summarized in the chart below.

Left Knee ROM
(Degrees)	NARSUM ~ 2.1 Mos. Pre-Sep
(20050613)	VA C&P 2.3 Mo. Post-Sep
(20051128)	
Flexion (140 Normal)	105	150	
Extension (0 Normal)	--	0	
Comment	Mild effusion.
Swelling.
Painful ROM.
	Able to walk indefinitely and clinical findings show no abnormality; Did note complaint of recurring pain and swelling when climbing stairs; With repetitive use, no additional loss of ROM due to pain, fatigue, weakness, instability, or incoordination.	
§4.71a Rating	PEB 10%	VA 0%	

The Board directs attention to its rating recommendation based on the above evidence.  The Board considered VASRD diagnostic code 5259 (cartilage, semilunar, removal of, symptomatic) which the PEB used for a 10% rating and coded 5260 (leg, limitation of flexion of) used by the VA for a 0% rating.  The Board agreed that the results of the lateral meniscectomy were symptomatic of pain, and limitations of physical activities such as running, stairs, squatting, swelling, popping, feeling of instability, and locking, which rose above the level of no limitations.  However, the limitations did not arise above the level of slight, for a higher moderate rating of 20% under code 5257 (knee, other impairment of).  There was no evidence in the clinical record of ankylosis, dislocated semilunar cartilage, bone mal-union, or ROM limitations, for a higher rating under alternate VASRD codes.  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 chronic left knee pain condition.

BOARD FINDINGS:  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 left knee pain 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 recharacterization of the CI’s disability and separation determination.

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20131025, 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-2013-01806

	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