RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXX	CASE:  PD-2014-01186
BRANCH OF SERVICE:  Army	BOARD DATE:  20150203
SEPARATION DATE:  20090109

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E-3 (Automated Logistical) medically separated for a bilateral knee condition.  The condition could not be adequately rehabilitated to meet the physical requirements of her Military Occupational Specialty.  She was issued a permanent L3 profile and referred for a Medical Evaluation Board (MEB).  The bilateral knee condition, characterized as “bilateral patellofemoral syndrome” was forwarded to the Physical Evaluation Board (PEB) IAW AR 40-501.  The MEB also identified and forwarded five other conditions (bilateral pes planus, abnormal pap smear, chronic sinusitis, left shoulder pain and headache disorder) for PEB adjudication.  The Informal PEB adjudicated “patellofemoral syndrome, bilateral” as unfitting, rated 20%.  The remaining conditions were determined to be not unfitting and therefore not ratable.  The CI made no appeals and was medically separated.

CI CONTENTION:  The CI elaborated no specific contention in her application.

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 20081016	VA - (4 Mos. Post-Separation) 	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Patellofemoral Syndrome, Bilateral	5099-5003	10%	Right Patellofemoral Syndrome with Mild Degenerative Changes	5299-5260	10%	20090521	
	5099-5003	10%	Right Patellofemoral Syndrome with Mild Degenerative Changes	5299-5260	10%	20090521	
Other x 5 (Not In Scope)	Other x 12	
Combined:  20%	Combined:  30%	
Derived from VA Rating Decision (VARD) dated 20090805 (most proximate to date of separation [DOS] with a C&P Exam).

ANALYSIS SUMMARY:

Bilateral Knee Condition.  The CI first developed bilateral knee pain, without associated injury or trauma, while in basic training in 2006.  Despite physical therapy, activity modification and pain medication, improvement was insufficient to allow performance of physical training activities.  Imaging studies showed minimal degenerative changes of cartilage bilaterally.  The narrative summary evaluation, 4 months prior to separation, noted a chief complaint of knee pain that was constant and worse through the day related to increased time on her feet.  The pain limited her outdoor activities.  Physical examination showed an unwillingness to perform a squatting maneuver due to fear of pain.  A diagnosis of patellofemoral syndrome was rendered.

At the VA Compensation and Pension exam performed 4 months after separation, the CI reported that she could not run or tolerate prolonged standing or squatting.  She occasionally used over-the-counter knee braces for support.  Examination showed a normal gait and intact knee ligaments.  There was no pain with motion after repetitive motion.

The goniometric range-of-motion (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.

Knee ROM
(Degrees)	PT ~4 Mos. Pre-Sep	NARSUM ~4 Mos. Pre-Sep	VA C&P ~4 Mos. Post-Sep	
	Left	Right	Left	Right	Left	Right	
Flexion (140 Normal)	143	140	140	140	135	135	
Extension (0 Normal)	-10*	0	0	0	0	0	
Comment	--	--	No tenderness or painful motion	+Mild crepitus; no tenderness or painful motion	
§4.71a Rating	10%*	10%*	10%*	10%*	10%*	10%*	
             *Hyperextension
             **Conceding VASRD §4.40 (functional loss) or §4.59 (painful motion)

The Board directed attention to its rating recommendation based on the above evidence.  Although the PEB adjudicated a bilateral condition, each knee was rated separately and the bilateral factor appropriately applied.  There was no compensable limitation of motion noted on any examination, and the PEB cited pain with use (§4.40) as justification for separate 10% ratings.  The Board considered other coding pathways to a rating higher than 10%.  There was no evidence of recurrent subluxation or lateral instability, no history of dislocated semilunar cartilage and no history of removal of semilunar cartilage to warrant ratings under codes 5257 (knee, other impairment of), 5258 (dislocated semilunar cartilage) or 5259 (cartilage, semilunar, removal of, symptomatic).  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 bilateral patellofemoral syndrome 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.  In the matter of the bilateral patellofemoral syndrome 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 20140302, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans’ Affairs Treatment Record

		

SAMR-RB									

MEMORANDUM FOR Commander

SUBJECT:  Department of Defense Physical Disability Board of Review Recommendation for XXXXXXXXXXXXXXX, AR20150009564 (PD201401186)

I have reviewed the enclosed Department of Defense Physical Disability Board of Review (DoD PDBR) recommendation and record of proceedings pertaining to the subject individual.  Under the authority of Title 10, United States Code, section 1554a,   I accept the Board’s recommendation and hereby deny the individual’s application.  This decision is final.  The individual concerned, counsel (if any), and any Members of Congress who have shown interest in this application have been notified of this decision by mail.

 BY ORDER OF THE SECRETARY OF THE ARMY:

Encl		     
						         
CF: 
(  ) DoD PDBR
(  ) DVA