RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXXXX	CASE:  PD-2014-03766
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20050627

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E6, Human Resources Specialist, medically separated for “chronic bilateral knee pain” with a disability rating of 10%.

CI CONTENTION:  “Patellofemoral Syndrome.”  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 - 20050519	VARD - 20050901	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Bilateral Knee Pain	5099-5003	10%	Left Knee Condition	5299-5260	NSC	20050510	
			Right Knee Condition	5299-5260	NSC	20050510	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  NSC	

ANALYSIS SUMMARY:  

Chronic Bilateral Knee Pain.  According to the service treatment record (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI dislocated her left patella (knee cap) at age 13 and was treated with surgery.  This was reported at her military entrance examination in December 1996.  In July 1997, the CI sought treatment for knee pain with no report of trauma.  The February 2005 Physical Fitness Test Scorecard showed the CI successfully completed a three event test, which included the alternate aerobic walk event. 

At the time of the orthopedic clinic appointment on 10 March 2005, the CI reported left knee arthroscopy in the early 1990’s, now with worsening symptoms of left knee pain greater than right, with prolonged running, squatting, kneeling and maneuvering stairs.  She denied swelling, locking or giving way.  The CI reported no relief with physical therapy (PT), medication or bracing.  On examination there was no effusion, but “slight valgus thrust left leg from knee” was noted.  There was mild medial and lateral facet tenderness and mild patellar tendon tenderness to palpation (TTP) of the left knee only.  There was negative anterior/posterior drawer, negative joint line tenderness, negative McMurray’s, and negative pivot shift.  Pain with squatting was noted. Active range of motion (ROM) was 0-120 degrees (normal 0-140).  No operative indications were recommended, and an MEB was recommended.  Despite treatment, the bilateral patellofemoral condition did not improve adequately to meet the physical requirements of the CI’s military specialty, and the CI was referred for an MEB.  The MEB forwarded “patellofemoral syndrome, bilateral, with chronic knee pain” for PEB adjudication.

At the MEB examination (recorded on DD Forms 2807 and 2808) dated March 2005, 3 months prior to separation, the CI reported painful knees.  The examiner noted crepitus, stable ligaments and TTP.   The MEB NARSUM examination on 29 March and 1 April 2005 (3 months prior to separation) noted complaints of painful knees.  Physical examination referred to the DD Forms 2807 and 2808, and the 10 March orthopedic examination noted above.  Imaging studies from March 2005 were noted to be normal.

At the VA Compensation and Pension (C&P) examination in May 2005, performed 2 months before separation, the CI reported bilateral knee pain since 1997 “from an injury.”  The CI reported pain with prolonged standing and walking and difficulty squatting and negotiating stairs. 
The bilateral knee physical examination showed normal appearing knees with well-healed surgery scars on the left knee measuring 1 cm.  There was no ligamentous laxity and meniscal signs were absent.  Posture and gait were normal.  Flexion was 140 degrees (normal 140), and extension was 0 degrees (normal 0) for both knees.  Joint function was not additionally limited by pain, fatigue, weakness, lack of endurance or incoordination after repetitive use.  X-rays of both knees were normal. 

The Board directed attention to its rating recommendation based on the evidence.  The PEB assigned a 10% rating under VASRD code 5099-5003 (analogous to degenerative arthritis), citing application of the US Army Physical Disability Agency pain policy.  The VA did not service connect either knee based on the VA C&P examination 2 months before separation, citing pain alone without a diagnosed or identifiable underlying malady or condition does not in and of itself constitute a disability for which service connection may be granted.    

As noted above, the Board must first consider whether the left and right patellofemoral conditions were separately unfitting, having been de-coupled from a combined PEB adjudication.  Patellofemoral syndrome of both knees was implicated in the commander’s statement, identified on the permanent profile, and was noted to fail retention standards.  There was no limitation of motion which supported a rating under the diagnostic codes for limitation of flexion or extension (5260, 5261). However, there was evidence of painful motion with functional loss supporting a 10% rating (based on §4.59, §4.40 and §4.45).  The examinations proximate to separation did not demonstrate the presence of ligamentous instability or laxity (5257), and there was no history of dislocated meniscus or loose body causing frequent locking with recurrent effusions (5258), or history of surgery to remove a meniscus (5259) to support a rating under the respective codes.  There was no fracture, non-union, or malunion of the femur or tibia to support consideration under the respective codes for knee impairment related to long bone conditions (5255, 5262).  There was therefore no VASRD §4.71a route to a rating higher than a 10% rating under any applicable code, and no grounds for additional rating based on the presence of instability.  After due deliberation, and considering all of the evidence, the Board found insufficient cause to recommend a change in the PEB adjudication of the chronic bilateral knee pain. 

BOARD FINDINGS:  In the matter of the bilateral patellofemoral condition and IAW VASRD §4.59, §4.40 and §4.45, 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 re-characterization of the CI’s disability and separation determination.  

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20140815, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

MEMORANDUM FOR Commander

SUBJECT:  Department of Defense Physical Disability Board of Review Recommendation for XXXXXXXXXXXXXXXXXXXXX AR20160013798 (PD201403766)

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:

Enclosure

CF: 
(  ) DoD PDBR
(  ) DVA