RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2014-03553
BRANCH OF SERVICE:  AIR FORCE 	SEPARATION DATE:  20060501

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty, E3, Security Forces Technician, medically separated for “bilateral patellofemoral syndrome,” with a disability rating of 10%.  

CI CONTENTION:  The applicant requests consideration of all conditions in her application.  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 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 PEB – 20060327	VARD - 20060724	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Bilateral Patellofemoral Syndrome	5099-5003	10%	Patellofemoral Syndrome of the Right Knee	5299-5260	10%	20060724	
			Patellofemoral Syndrome of the Left Knee	5299-5260	10%	20060724	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  20%	

ANALYSIS SUMMARY:  

Bilateral Patellofemoral Pain Syndrome (PFS).  The CI initially presented with bilateral knee lower extremity pain in November 2005.  A bone scan demonstrated stress reaction changes bilaterally.  The CI was evaluated by orthopedic surgery with physical findings of bilateral knee tenderness to palpation, crepitus, entrapment of the patella, and full active range of motion (ROM). A diagnosis of bilateral PFS was rendered. She was treated with physical therapy, activity modification, and anti-inflammatory medications without pain resolution.  The narrative summary noted bilateral knee pain with running, prolonged standing, and walking.  The physical examination demonstrated bilateral tenderness to palpation, full active ROM, and patella entrapment.  The VA Compensation and Pension examination performed 3 months after separation, demonstrated full ROM with slight pain on motion.  There was increased pain, tenderness, and fatigue with repetitive motion.  

The Board directed attention to its rating recommendation based on the above evidence.  The PEB rated the bilateral PFS condition under a single Service disability rating of 10%, coded 5099-5003 (analogous to degenerative arthritis.  The VA rated each knee separately at 10%, coded 5299-5260 (leg limitation of flexion).  IAW DoDI 6040.44 if the PEB combined adjudication is not compliant VASRD rating criteria, each condition subsumed under the single Service disability rating must be reasonably justified as separately unfitting in order to remain eligible for Service rating.  The Board’s initial charge in this case was directed at determining if the PEB’s combined adjudication was justified in lieu of separate ratings. In this case a bilateral condition was profiled, determined to fail retention standards, and implicated in the commander’s statement.  Members agreed that each knee was separately unfitting and that identical coding and ratings were applicable.  There were subjective and objective evidence of pain with use and painful motion for a 10% rating for each knee. There was no evidence of instability or other criteria for a higher rating.  After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the Board recommended a disability rating of 10% for each knee.  

BOARD FINDINGS:  In the matter of the bilateral patellofemoral pain syndrome condition, the Board unanimously determined that each knee was separately unfitting and recommends a disability rating of 10%, for each knee, coded 5099-5003 IAW VASRD §4.71a.  There were no other conditions within the Board’s scope of review for consideration.  The Board recommends that the CI’s prior determination be modified as follows, effective as of the date of separation:

CONDITION	VASRD CODE	RATING	
Left Patellofemoral Pain Syndrome	5099-5003	10%	
Right Patellofemoral Pain Syndrome	5099-5003	10%	
COMBINED (w/ BLF)	20%	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20140714, 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-2014-03553.

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 not appropriate under the guidelines of the Veterans Affairs Schedule for Rating Disabilities.  Accordingly, the Board recommended modification of your assigned disability rating without re-characterization of your separation with severance pay. 

I have carefully reviewed the evidence of record and the recommendation of the Board.  I concur with that finding, accept their recommendation and direct that your records be corrected as set forth in the attached copy of a Memorandum for the Chief of Staff, United States Air Force.  The office responsible for making the correction will inform you when your records have been changed. 
Sincerely,

Attachment:
1.  Directive 
2.  Record of Proceedings 

cc:
SAF/MRBR