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AF | PDBR | CY2014 | PD-2014-00996
Original file (PD-2014-00996.rtf) Auto-classification: Denied
RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME: XXXXXXXXXXXXXXXXXXXX       CASE: PD-2014-00996
BRANCH OF SERVICE: AIR FORCE     BOARD DATE: 20150220
SEPARATION DATE: 20060508


SUMMARY OF CASE: Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E-3 (Aircraft Armament Systems) medically separated for a right knee condition. The right knee condition could not be adequately rehabilitated to meet the physical requirements of his Air Force Specialty. He was issued a L4 profile and referred for a Medical Evaluation Board (MEB). The right knee condition, characterized as “chronic right knee pain,” was forwarded to the Physical Evaluation Board (PEB) IAW AFI 48-123. No other conditions were submitted by the MEB. The Informal PEB adjudicated right knee pain status post arthroscopic medial meniscus repair/partial resection as unfitting, rated 10%, with referencing application of the Veterans Affairs Schedule for Rating Disabilities (VASRD). The CI made no appeals and was medically separated.


CI CONTENTION: “10% awarded for right knee. I’m losing mobility in right knee and losing flexibility in hips and lower back. I had a review of my case and the VA doctor told me they do not pay for pain and ended my review without examining my knee or loss of flexibility.”


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 when specifically requested by the CI, those conditions identified by the PEB, but determined to be not unfitting. Any conditions outside the Board’s defined scope of review and any contention not requested in this application may remain eligible for future consideration by the Board for Correction of Military/Naval Records. Furthermore, the Board’s authority is limited to assessing the fairness and accuracy of PEB rating determinations and recommending corrections, where appropriate. The Board’s assessment of the PEB rating determinations is confined to review of medical records and all available evidence for application of the Veterans Affairs Schedule for Rating Disabilities (VASRD) standards to the unfitting medical condition at the time of separation. The Board has neither the role nor the authority to compensate for post-separation progression or complications of service-connected conditions. That role and authority is granted by Congress to the Department of Veterans Affairs, operating under a different set of laws. The Board gives consideration to VA evidence, particularly within 12 months of separation, but only to the extent that it reasonably reflects the severity of the disability at the time of separation.


RATING COMPARISON :

Service IPEB – Dated 20060227
 VA - (4.3 Mos. Post-Separation)
Condition
 Code Rating Condition Code Rating Exam
Right Knee Pain…. 5259 10% Chondromalacia Right Knee 5099-5014 10% 20060906
Other x 0 (Not in Scope)
Combined: 10%
 Combined: 20%
Derived from VA Rating Decision (VA RD ) dated 200 61226 ( most proximate to date of separation [ DOS ] ).


ANALYSIS SUMMARY:

Right Knee Condition. The CI presented to the Department of Emergency Medicine on 14 November 2003 with right lower extremity pain as a result of a fall. X-rays were negative and treatment was with a nonsteroidal anti-inflammatory medication. In September 2004, he presented with a twisted knee of 3 months duration associated with locking, popping, and occasional giving out. Examination of the right knee on 24 September 2004 revealed “obvious quad atrophy” raising the possibility of patellofemoral pain syndrome symptoms versus patellar instability; and treatment was with a knee sleeve. Examination on 6 October 2004 revealed the right knee range-of-motion (ROM) 120 degrees with medial joint line tenderness with “good quad tone.” In spite of physical therapy, the symptoms of popping and pain in the right knee persisted. An admission note dated 22 March 2005 noted right knee tenderness at the lateral joint line tenderness and a positive McMurray’s test (meniscal involvement). A right knee arthroscopic examination under anesthesia and an abrasion chondroplasty were performed on 22 March 2005 with the postoperative diagnosis of “Grade III PF” (patellar-femoral-partial thickness cartilage loss). Follow-up on 22 August 2005 indicated the CI could not kneel and squat secondary to constant pain, grinding, and swelling. A note dated 12 October 2005 indicated crepitus with flexion-extension under the patella with no laxity; and the diagnosis was knee pain secondary to chronic chondromalacia. A 4LT profile was issued on 23 November 2005 with a limitation of running and the CI was not mobility qualified or eligible for reassignment. The commander’s statement dated 28 November 2005 indicated the CI could not do any work in his primary position due to his profile and had been on convalescent leave for two weeks after surgery in “Apr 05.” The commander’s statement did not address a second surgery. The MEB narrative summary (NARSUM) dated 20 January 2006 indicated the CI developed right knee pain in November 2003 while at basic training while attempting to jump over a barrier on the obstacle course and was seen in the emergency room on 13 November 2003. He had a confirmatory magnetic resonance imaging in January 2005 that indicated a “complex tear of the posterior horn of the medial meniscus” and “[p]ossible degenerative change of the patellofemoral joint cartilage versus artifact.” The NARSUM noted that the CI had “surgery on 21 Mar 2005 for right medical meniscus repair under anesthesia and abrasion chondroplasty;” and also noted the CI “underwent a second surgery for re-evaluation and abrasion chondroplasty on 15 Jun 05.” It concluded that the CI “had two surgeries and completed rehabilitation and continues to have debilitating pain and cannot perform active duty requirements.”

At the VA Compensation and Pension (C&P) examination dated 6 September 2006, performed approximately 4 months after separation, the CI reported that in October 2003 he fell off an obstacle course and landed on his right knee and experienced a popping sensation and collapse of his knee. He had arthroscopic surgery in “04/05 when he had bilateral meniscectomy done.” He denied recent physical therapy, took Mobic (a nonsteroidal anti-inflammatory medication) daily with a good response, and used a brace for the right knee. He had constant 3/10 mild pain with periods of swelling. He denied heat, redness, instability or locking, but standing more than 8 hours or weather changes caused a flare-up of 6/10 pain. The ROM for flexion of the right knee was 0 degrees-120 degrees with pain and extension was 0 degrees. There was no additional limitation by pain, fatigue, weakness, lack of endurance or repetitive use. A temporally remote (64 months post-separation) VA C&P examination was reviewed; however, it offered very limited or no probative post-separation evidence of any significant value, but did note there was no medical or surgical intervention after separation.

The Board directed attention to its rating recommendation based on the above evidence. The PEB assigned a 10% rating using code 5259 (semilunar cartilage removal) for right knee pain status post arthroscopic medial meniscus repair/partial resection with [a] current normal exam. The VA assigned a 10% rating using code 5099-5014 (osteomalacia) for chondromalacia of the right knee. The Board sought a route to a higher 20% rating and noted that the criteria for code 5258 (dislocated semilunar cartilage with frequent episodes of “locking” and effusion into the joint) were not documented or referred to in the record, although pain was frequently mentioned. Additionally there was no indication of laxity to support an additional rating using code 5257 (knee impairment-recurrent subluxation or lateral instability). 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 right knee 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 right 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.


The following documentary evidence was considered:

Exhibit A. DD Form 294, dated 20140117, w/atchs
Exhibit B. Service Treatment Record
Exhibit C. Department of Veterans’ Affairs Treatment Record









XXXXXXXXXXXXXXXXXXXX
President
DoD Physical Disability Board of Review


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

 Reference your application submitted under the provisions of DoDI 6040.44 (Title 10 U.S.C. § 1554a), PDBR Case Number PD-2014-00996.
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,





XXXXXXXXXXXXXXXXXXXX
Director
Air Force Review Boards Agency

Attachment:
Record of Proceedings

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