RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXX	CASE:  PD-2013-02008
BRANCH OF SERVICE:  AIR FORCE	BOARD DATE:  20140624
SEPARATION DATE:  20051011

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty SRA/E-4 (2M052/Missile and Space Systems Maintenance Journeyman) medically separated for a bilateral knee condition.  The condition could not be adequately rehabilitated to meet the physical requirements of his Air Force Specialty or satisfy physical fitness standards.  He was issued a permanent L4 profile and referred for a Medical Evaluation Board (MEB).  Bilateral degenerative joint disease (DJD) and chondromalacia, characterized as not meeting retention standards, were forwarded to the Physical Evaluation Board (PEB) IAW AFI 48-123.  No other conditions were submitted by the MEB.  The Informal PEB adjudicated DJD, both knees associated with chondromalacia as a single unfitting condition, rated 20%, referencing the VA Schedule for Rating Disabilities (VASRD).  The CI made no appeals and was medically separated.

CI CONTENTION:  “I would like all MEB/PEB conditions for being unfit for duty and rated.  The first rating that I got dealt with the knee problem I was experiencing.  I feel it should have considered the mental problems associated with immobility, pain and dependency to the narcotics I was being prescribed for knee pain.  Upon leaving the military, I immediately was struggling with these issues.  Within a month I was admitted into a mental health hospital. By the end of the year I was admitted to a hospital with acute pancreatitis and having my gallbladder removed.  The first mental health rating that the VA gave me was 10%. And sadly it was based on one thing, whether or not I was abusing the prescription painkillers I had become dependent on while serving in the military.  I told the VA no, and that I had no intention of taking them anymore.  However I still had severe knee pain to deal with and soon was taking the pain medications again.  I now know what a huge mental health problem I was dealing with upon separation from the military and I wish I had received more help with it while active duty. Perhaps my military career could have been much more successful.”

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 bilateral knee condition is addressed below; no additional conditions are within the DoDI 6040.44 defined purview of the Board.  The contended mental health issue was not identified by the PEB and is not within the DoDI 6040.44 defined purview of the Board.  Any condition 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.

RATING COMPARISON:

Service IPEB – Dated 20050817	VA*	
Condition	Code	Rating	Condition	Code	Rating	Exam	
DJD, Both Knees associated with Chondromalacia	5003	20%	Patellofemoral Pain Syndrome, Left Knee, s/p Surgical Procedure	5299-5259	10%	20110919*	
			Patellofemoral Pain Syndrome, Right Knee, s/p Surgical Procedure	5299-5259	10%	20110919*	
Other x 0 (Not in Scope)	Other x 10	20110919*	
Rating:  20%	Combined:  40%	
* Derived from VA Rating Decision (VARD) dated 20111118 (VARD and C&P examinations most proximate to date of separation not in evidence)

ANALYSIS SUMMARY:  IAW DoDI 6040.44, the Board’s authority is limited to making recommendations on correcting disability determinations.  The Board’s role is thus confined to the review of medical records and all evidence at hand to assess the fairness of PEB rating determinations, compared to VASRD standards, based on ratable severity at the time of separation.  The Board noted the absence of the VA Compensation and Pension (C&P) exam from the record performed most proximity to the date of separation.  The Board further noted that the VARD referenced, in detail, the results of this exam in the explanation of its rating decision.  Members deliberated if the absence of the original VA document would negatively impact their ability to render a fair assessment.  The Board unanimously agreed that the evidence referenced in the available VARD was sufficiently probative such that the missing document would not materially affect the Board’s final recommendation.

Bilateral DJD of the knees with Chondromalacia.  Treatment records show the CI first presented with bilateral knee pain in 2003.  At that time he reported increasing pain with activity, weather changes, with stiffness and popping.  The physical examination was significant for normal range-on-motion (ROM), tenderness and mild pain with patellar compression.  He was diagnosed with chronic bilateral knee pain and treated with conservative management (physical therapy and nonsteroidal anti-inflammatory medication).  Despite conservative management the CI continued to report bilateral knee pain and underwent Maquet procedures (right October 2004, left March 2005).  The narrative summary performed 4 months prior to separation notes that the CI had significant decreased ROM of his knees and ambulated with a cane due to pain.  The physical examination noted well healed surgical scars, full ROM and tenderness to palpation bilaterally.  Radiographic evaluation was noted to evidence mild to severe degenerative joint disease. Diagnoses of severe bilateral DJD and chondromalacia were rendered.  The VA C&P examination was not on record.

The Board directs attention to its rating recommendation based on the above evidence.  The PEB adjudicated the DJD, both knees associated with chondromalacia condition as unfitting with a disability rating of 20%, coded 5003.  The VA rated knee condition as patellofemoral pain syndrome, status post surgical procedure analogous to cartilage, semilunar, removal of, symptomatic at 10% for each knee.  The Board determined that the evidence supports that each knee was separately unfitting and met the criteria for a 10% rating IAW VASRD §4.59 painful motion for a combined rating of 20%.  There was no evidence of instability, nerve involvement and compensable limitation of motion for a higher rating.  After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the Board concluded that the recommendation would not change the overall rating for the CI therefore and that there was insufficient cause to recommend a change in the PEB adjudication for the DJD, both knees associated with chondromalacia 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 DJD, both knees associated with chondromalacia condition and IAW VASRD §4.71a, the Board determined that each knee was separately unfitting and met the criteria for a 10% rating IAW VASRD §4.59 painful motion for a combined rating of 20%.  However, because this recommendation would not result in an increase above the 20% PEB rating, 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 20131030, 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-2013-02008.

	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