RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:   XXXXXXXXXXXXXXXXXXXX	CASE:  PD-2014-01951
BRANCH OF SERVICE:  AIR FORCE 	BOARD DATE:  20150116
SEPARATION DATE:  20070609

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E-3 (Security Forces Helper) medically separated for left patellofemoral syndrome.  The condition could not be adequately rehabilitated to meet the physical requirements of her Air Force Specialty or satisfy physical fitness standards.  She was placed on training temporary duty restriction and referred for a Medical Evaluation Board (MEB).  The left knee condition was forwarded to the Physical Evaluation Board (PEB) IAW AFI 48-123.  No other condition was submitted by the MEB.  The Informal PEB adjudicated “left patellofemoral syndrome” as unfitting, rated 10%, citing application of the Department of Defense Instruction (DoDI) 1332.39 and Veterans Affairs Schedule for Rating Disabilities (VASRD).  The CI made no appeals and was medically separated.  

CI CONTENTION:  The applicant requests consideration of all of her conditions.  Her complete submission is at Exhibit A.

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 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 20070430	VA* - based on Service Treatment Records (STR)	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Left Patellofemoral Synd.	5099-5003	10%	Left Patella Femoral Syndrome	5299-5260	10%	STR	
Other x 0 (Not In Scope)	Other x 1	
RATING:  10%	RATING:  10%	
*Derived from VA Rating Decision (VARD) dated 20070822 (most proximate to date of separation (DOS)).

ANALYSIS SUMMARY:  

Left Patellofemoral Syndrome.  The narrative summary noted the CI reported left knee and ankle pain a few weeks after completing basic training due to a fall during a run.  Radiographs of the lower leg 24 August 2006 were normal and a bone scan 28 September 2006 showed moderate stress changes of the left ankle and mild changes of both knees and feet.  The CI was given training restrictions, and treated conservatively without improvement.  Orthopedic evaluation 11 December 2006 noted an antalgic gait, tenderness of the patellofemoral region, a positive patellar grind test, and signs of semilunar cartilage injury, but no lateral or anterior-posterior instability.  Strength and reflexes were normal.  Left knee X-rays were normal.  The orthopedic evaluation was patellofemoral syndrome, but a magnetic resonance imaging (MRI) scan was ordered to rule out a meniscal tear.  At a primary care visit on 2 February 2007, the CI reported a continued “locking sensation,” especially with stairs.  The examiner noted that there was no knee swelling or popping and the knee did not seem “out of place,” with the remainder of the examination unchanged.  A follow-up orthopedic visit on 26 February 2007 noted the MRI impression of “no evidence of meniscal tear.”  The orthopedic recommendation was an extended period of rest of 6-12 months with consideration of return once the patellofemoral condition had resolved and a MEB was initiated.  At the MEB examination performed on 3 December 2007, 6 months prior to separation, the CI reported left knee pain aggravated by activity.  The CI reported her kneecap felt unstable and would lock up or catch during movement.  The MEB physical exam noted a normal knee appearance with full ROM with painful motion, tenderness to palpation of the knee around the patella, and tenderness with walking.  The original VARD dated 22 August 2007 noted that the CI did not attend a scheduled post-separation VA Compensation and Pension examination on 26 July 2007 and the rating decision was based upon service medical records.  

The Board directed its attention to its rating recommendation based on the above evidence.  The PEB rated the left knee condition 5099-5003 (analogous to degenerative arthritis) and the VA also rated it 10%, coded 5299-5260 (analogous to limitation of leg flexion) and cited painful motion, but no compensable rating based on limitation of ROM alone.  The Board agreed that the evidence in record supports a 10% rating with multiple applicable codes IAW VASRD §4.71a. for painful motion IAW VASRD §4.59 (Painful motion).  The Board reviewed to see if any higher evaluation was achieved with any applicable §4.71a code, but there was no evidence of compensable limitation of ROM, instability, semilunar cartilage related symptoms or removal, or impairment of the femur, tibia, or fibula resulting in knee disability, and no evidence of any other ratable impairment of the knee.  After due deliberation in consideration of the preponderance of the evidence, the Board concluded that there was insufficient cause to recommend a change in the PEB fitness determination for the left 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.  As discussed above, the PEB may have relied on DoDI 1332.39 for rating the left knee condition and the condition was adjudicated independently of that instruction by this Board.  In the matter of the left 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 20140505, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

		
SAF/MRB
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-2014-01951.

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