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AF | PDBR | CY2013 | PD2013 02641
Original file (PD2013 02641.rtf) Auto-classification: Denied
RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME: XXXXXXXXXXXXXXXXXX         CASE: PD1302641
BRANCH OF SERVICE: AIR FORCE     BOARD DATE: 20140523
SEPARATION DATE: 20050705


SUMMARY OF CASE: Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty SrA/E-4 (2T251/Cargo Journeyman) medically separated for left knee pain. The condition could not be adequately rehabilitated to meet the requirements of her Air Force Specialty or physical fitness standards. She was issued a permanent L4 profile and referred for a Medical Evaluation Board (MEB). The left knee condition, characterized as “chronic left knee pain,” was forwarded to an Informal Physical Evaluation Board (IPEB) IAW AFI 48-123, with no other conditions submitted by the MEB. The PEB adjudicated “chronic left knee pain…” as unfitting (Category I), rated 10%. The CI did not concur with the IPEB and demanded a Formal PEB, which upheld the findings of the IPEB and again rated the left knee at a 10% disability. The CI made no appeals and was medically separated.


CI CONTENTION: “Left knee ACL reconstruction” was the extent of the contention, with further reference in block 13 (documents in support of this application) to a rating increase by the VA.


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 DoDI 6040.44 defined purview of the Board. 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 CI’s information regarding the significant impairment with which her service-connected condition continues to burden her, but must emphasize the Disability Evaluation System has neither the role nor the authority to compensate members for later severity or complications of conditions which resulted in medical separation. That role and authority is granted by Congress to the Department of Veterans Affairs (DVA), operating under a different set of laws. The Board considers DVA evidence proximate to separation in arriving at its recommendations, and DoDI 6040.44 defines a 12-month interval for special consideration to post-separation evidence. Post-separation evidence is probative to the Board’s recommendations only to the extent that it reasonably reflects the disability at the time of separation.


RATING COMPARISON :

Service FPEB – Dated 20050517
 VA - (2 Mos. Post-Separation)
Condition
 Code Rating Condition Code Rating Exam
Chronic Left Knee Pain 5257 10% Residual Instability of Left Knee… 5257 10% 20050907
Residual Crepitus w/ Painful Motion of Left Knee, Status Post ACL Repair 5260 10%
Residual Scar on Left Knee… 7804 0%
No Additional MEB/PEB Entries
 Other x 5
Combined: 10%
 Combined: 30%
Derived from VA Rating Decision (VA RD ) dated 200 60215 .


ANALYSIS SUMMARY:

Left Knee Condition. The service treatment record (STR) confirms that the CI had a knee twisting injury on 8 December 2003 stepping off a K-Loader while on duty at ramp services in the aerial port. A magnetic resonance imaging study on 3 March 2003 found a tear of the anterior cruciate ligament (ACL). She underwent surgery on 6 April 2004 consisting of a left ACL reconstruction with hamstring graft. She responded favorably to physical therapy. However, after returning to military duties, the CI had a left knee twisting re-injury and she continued to experience discomfort of the left knee and feelings of instability with left knee buckling forward despite wearing a knee brace. Various entries in the STR during the post-surgical course document grossly normal range-of-motion (ROM) and normal gait. Orthopedic follow-up 3 months prior to separation noted a 1+ Lachman’s test (1-5mm) with a very firm endpoint indicating minimal ACL laxity. The VA Compensation and Pension examination performed 2 months after separation found a “very slightly positive anterior drawer sign” for ACL laxity and 5 degrees of valgus lateral instability also indicating ACL laxity. The examiner classified the findings as minimal instability, without pain upon normal ROM or repetitive use.

The goniometric ROM evaluations in evidence 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)
MEB ~ 4 Mo. Pre-Sep
(200 50311 )
Ortho ~ 3 Mo. Pre-Sep
(200 50421 )
VA C&P ~ 2 Mo. Post-Sep
(200 50907 )
Flexion (140 Normal)
 135 “full ROM” 145
Extension (0 Normal)
 0 “full ROM” 0
Comment
 Healed scars.
1+ Lachman’s with firm end point.
Mild tenderness anteromedial joint line and over the screw head.
No redness, no swelling, no effusion,		 Positive anterior drawer.
Valg us 5˚ laxity .
Anterior crepitus on extension.
 No pain on ROM.
 Normal gait.
 Giving way almost daily.
§4.71a Rating
 10 % 10 % 10 %

The Board directs attention to its rating recommendation based on the above evidence. The Board considered the VA Schedule for Rating Disabilities (VASRD) code 5257 (knee, other impairment of: recurrent subluxation or lateral instability) used by both the PEB and VA for a 10% rating. The Board found a left knee re-injury reported on 10 March 2005 after surgery, stepping off a curb twisting her knee and reports of left knee intermittently giving way, at the time of separation. Additionally, there were physical findings of slight ACL ligament laxity. The Board considered these findings arose to the level of slight instability, but did not approach the moderate level for a higher adjudication. The Board specifically considered and extensively debated code 5260 (leg, limitation of flexion of) used by the VA for an additional 10% rating. The Board could not find evidence of any ROM restriction of flexion limited to ≤45 degrees required for a rating of 10% or any other findings that could reasonably overcome the VASRD §4.14 avoidance of pyramiding policy which states that the evaluation of the same disability under various diagnoses is to be avoided. The Board additionally deliberated if code 5003 (degenerative arthritis) could be applied to this case. The Board concluded that without arthritis established by radiological findings this code could not be applied to the left knee condition. There were no other compensable range of motion limitations, frequent episodes of locking pain or effusions, no painful ranges of motion, and no radiological findings of arthritis for a higher rating under alternate knee codes above 10%. The Board did not find any evidence for a possible separately unfit and ratable residual disability related to the knee surgical scar rating which the VA rated as zero percent coded 7804 (scars, superficial, painful on examination). 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 left knee condition.


BOARD FINDINGS: The Board surmised from the record or PEB ruling in this case that no prerogatives outside the VASRD were exercised. In the matter of the left knee condition and IAW VASRD §4.71a, the Board unanimously recommends no change in the PEB adjudication.


RECOMMENDATION: The Board, therefore, recommends no recharacterization of the CI’s disability and separation determination.


The following documentary evidence was considered:

Exhibit A. DD Form 294, dated 20131212, w/atchs
Exhibit B. Service Treatment Record
Exhibit C. Department of Veterans’ Affairs Treatment Record








                                   
XXXXXXXXXXXXXXXXXX
President
Physical Disability Board of Review


 SAF/MRB
1500 West Perimeter Road, Suite 3700
Joint Base Andrews, MD 20762

 XXXXXXXXXXXXXXXXXX
XXXXXXXXXXXXXXXXXX
XXXXXXXXXXXXXXXXXX

Dear XXXXXXXXXXXXXXXXXX :

         Reference your application submitted under the provisions of DoDI 6040.44 (Title 10 U.S.C. §  1554a), PDBR Case Number PD-2013-02641.

         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,




XXXXXXXXXXXXXXXXXX
Director
Air Force Review Boards Agency
Attachment:
Record of Proceedings

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