RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME: XXXXXXXXXXXXXXXXXX	CASE:  PD-2014-01043
BRANCH OF SERVICE:  Air Force 	SEPARATION DATE:  20090626

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E5, Enterprise Controller and 2T271 Air Transportation Craftsman, medically separated for “bilateral knee pain due to patellofemoral syndrome (PFS),” with a disability rating of 10%.

CI CONTENTION:  The CI contends his condition has worsened and impairs his daily activities.  He also contends his condition deserves a higher rating.  The CI’s complete submission is at Exhibit A.  

SCOPE OF REVIEW:  The Board’s scope of review is defined in DoDI 6040.44.  It is limited to those conditions determined by the Physical Evaluation Board (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 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 based upon a 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 PEB - 20090402	VARD - 20090727	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Bilateral Knee Pain due to Patellofemoral Syndrome	5299-5261	10%	Patellofemoral Syndrome, Right Knee	5260	10%	20090605	
			Patellofemoral Syndrome, Left Knee	5260	10%	20090605	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  20%	

ANALYSIS SUMMARY:  

Bilateral Knee Pain.  According to service treatment record (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI developed bilateral (right > left) knee pain in 2003.  Initial x-rays were normal.  Despite conservative treatment to include physical therapy (PT), manipulations, rest, and medication, the CI’s painful symptoms remained and worsened in the right knee.  Diagnostic studies revealed a mal-aligned right kneecap and a tear in the right medial meniscus.  On 31 January 2008, he underwent a right kneecap re-alignment procedure.  Six months after surgery (12 months prior to separation) his right knee examination was normal excepting ‘slight’ tenderness about the right kneecap tendon.  His knee conditions could not be adequately rehabilitated to meet the physical requirements of the CI’s military specialty and he was referred for MEB.  The MEB forwarded “bilateral knee pain” for PEB adjudication.  

At the MEB Narrative Summary (NARSUM) examination dated 01 December 2008, approximately 7 months before separation, the CI reported continued bilateral knee pain with right knee weakness.  His physical examination (PE) revealed a normal gait with bilateral knee crepitus and tenderness.  There was no swelling, effusion or redness of either knee.  His final diagnosis was listed as pain status post-surgery of the right knee and PFS bilaterally; right > left.  At the VA Compensation and Pension (C&P) examination dated 05 June 2009, 3 weeks prior to separation, the CI reported bilateral knee pain (right > left) with bending, maneuvering stairs, and prolonged running.  The CI denied history of either knee locking or becoming unstable.  He further denied history of painful flare-ups nor does he require the use of any assistive device.  His knee-focused PE revealed normal knee extension and minimal decreased range of motion (ROM) of flexion at 130 degrees (right knee) and 120 degrees (left knee); (normal140).  Painful motion was observed at terminal ROM.  No instability was present and his gait was normal.  Under the heading of “Diagnosis”, the VA examiner noted, “No objective findings for condition left knee.” 

The Board directed attention to its rating recommendation based on the above evidence.  The PEB combined the right and left knee conditions under a single disability rating, coded analogously to 5261 (leg; limitation of extension) and rated 10% whereas the VA separately rated each knee at 10% utilizing VASRD code of 5260 (leg; limitation of flexion), citing painful and limited motion.  The Board’s initial charge in this case was directed at determining if the PEB’s approach of combining conditions under a single rating was justified in lieu of separate ratings.  Although the VA examination was closest to the date of separation, the minimal objective findings of the left knee noted by the VA examiner, having been de-coupled from the combined PEB adjudication, indicated the left knee was less impaired.   The Board determined the totality of the STR evidence clearly portrayed much stronger evidence that the right knee was the primary focus of the CI’s overall impairment, and concluded that the evidence of minimal functional loss as well as crepitus and tenderness in both knees supported that either knee as being unfit and should be separately rated.  After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the Board recommends a disability rating of 10% for the right knee and 0% for the left knee condition for an overall combined 10%.  The Board agreed there existed no additional rating benefit to the CI to unbundle the PEB’s adjudication and therefore, the Board recommends no change in the current rating disability of a combined 10%.  

BOARD FINDINGS:  In the matter of the bilateral 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.  The Board, therefore, recommends that there be no modification or re-characterization of the CI’s disability and separation determination.

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20140225, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

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

Dear XXXXXXXXXX:

Reference your application submitted under the provisions of DoDI 6040.44 (Section 1554, 10 USC), PDBR Case Number PD-2014-01043.

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,

Attachment:
Record of Proceedings