RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXXXX	CASE:  PD-2014-04362
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20090427

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E4, Aviation Operations Specialist, medically separated for “bilateral patellofemoral pain syndrome” with a disability rating of 20%.

CI CONTENTION:  “Other medical issues were not considered in determining final 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 on 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 - 20081114	VARD - 20091209	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Bilateral PFPS	5099-5003	20%	Right Knee Condition	5257	0%	20090625	
			RPPS, Left Knee	5260	0%		
Hypertension	Not Unfitting 	Hypertension	7101	0%		
Cervicalgia		Cervical Spine Condition	5237	10%*		
Chronic Low Back Pain		Lumbar Spine Condition	5237	10%*		
Headache		Muscle Tension Headaches	8100	0%		
Paresthesias/numbness in bilateral hands/CTS		CTS, Left Hand	8599-8515	10%*		
		CTS, Right Hand	8599-8515	10%*		
Hyperlipidemia		No VA Placement		
Endometriosis		Endometriosis/Pelvic Adhesions	7629	30%*		
Pelvic Pain						
Dyspareunia		No VA Placement		
COMBINED RATING:  20%	COMBINED RATING OF ALL VA CONDITIONS:  60%*	
*DRO Review dated 20110309 and retroactive to separation

ANALYSIS SUMMARY:  

Bilateral Patellofemoral Pain Syndrome (PFPS).  According to service treatment records and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s bilateral knee condition began in May 2007 after ruck marching.  She was treated with duty modifications and medications without resolution of her pain.  X-ray studies on 17 September 2007 were normal.  She was thought to have bilateral patellofemoral syndrome (PFS) and referred to physical therapy (PT) for rehabilitation.  Magnetic resonance images of each knee on 14 February 2008 were normal.  Due to failure to progress, she was referred to orthopedics on 14 March 2008.  Instability was not recorded.  Her gait was normal.  The range of motion (ROM) was “limited,” but pain free.  MEB was recommended.  At the MEB 2807 evaluation on 14 May 2008, the CI reported that her pain began in April 2007 after a 3 mile ruck march.  On examination, she was noted to have painful motion and tenderness.  The ROM was full.  No effusion was present.  Instability was not documented. 
 
The MEB narrative summary (NARSUM) was dated 2 July 2008, 10 months prior to separation.  The CI again reported chronic bilateral knee pain which began after a ruck march.  She reported that her pain persisted despite treatment and was aggravated by activity and prolonged sitting.  On examination, the knees were not tender, but “grinding” the kneecaps was painful.  The knees were stable and provocative testing of the menisci (cartilage cushions between the bones of the knee) was negative.  She reported pain at the extremes of motion.  Crepitus (an audible or sensible sensation of grating on movement) was present.  The ROM was reduced and is charted below.  

At the 25 June 2009 VA Compensation and Pension (C&P) evaluation performed on 25 June 2009, 2 months after separation, the CI reported constant knee pain which was aggravated by standing, walking, or sitting for prolonged periods and negotiating steps.  The examination, including the ROM and testing for instability, was normal.  The 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. 

Right Knee ROM
(Degrees)	PT ~19 Mos. Pre-Sep	MEB ~10 Mos. Pre-Sep	VA C&P ~2 Mos. Post-Sep	
Flexion (140 Normal)	Full ROM	111/111/110	140	
Extension (0 Normal)	Full ROM	5/6/5	0	
Comment	Normal gait/tenderness present/pain present/no effusion/	Tenderness present/painful motion/crepitus/ patellar grind 	Normal examination	
§4.71a Rating	10%	10%	0%	

The Board directed attention to its rating recommendation based on the above evidence.  The PEB rated the each knee at 10%, coded 5099-5003 (arthritis, degenerative (hypertrophic or osteoarthritis)), citing limitation of motion.  The VA rated the right knee pain and left knee retro-patellar pain syndrome (RPPS) conditions at 0% each, coded 5257 (knee, other impairment of:  recurrent subluxation or lateral instability) and 5260 (limitation in flexion), respectively, noting a normal examination.  No criteria for a higher rating were present for either knee.  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 right or left knee conditions.

Contended PEB Conditions.  The CI also contended for hypertension (high blood pressure), cervicalgia (neck pain), chronic low back pain (LBP), headache, paresthesias/numbness in bilateral hands and carpal tunnel syndrome, hyperlipidemia (cholesterol and other lipids), endometriosis (implants of uterine tissue outside the uterus), pelvic pain, and dyspareunia (painful intercourse).  The Board’s main charge is to assess the fairness of the PEB’s determination that the contended conditions were not unfitting.  None of the conditions were profiled at separation and none were implicated in the commander’s statement.  All were judged to meet retention standards.  There was no performance-based evidence from the record that any of the conditions significantly interfered with satisfactory duty performance at separation.  After due deliberation, the Board concluded that there was insufficient cause to recommend a change in the PEB fitness determination for any of the contended conditions and so no additional disability ratings are recommended.  

BOARD FINDINGS:  In the matter of the bilateral patellofemoral pain syndrome condition and IAW VASRD §4.71a, the Board unanimously recommends no change in the PEB adjudication.  In the matter of the contended hypertension, cervicalgia, chronic low back pain, headache, paresthesias/numbness in bilateral hands, hyperlipidemia, endometriosis, pelvic pain, dyspareunia, and carpal tunnel syndrome conditions, the Board unanimously recommends no change from the PEB determinations as not unfitting.  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 20141218, with attachments
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

MEMORANDUM FOR Commander, US Army Physical Disability Agency 
(AHRC-DO), 2900 Crystal Drive, Suite 300, Arlington, VA  22202-3557

SUBJECT:  Department of Defense Physical Disability Board of Review Recommendation for AR20160011859 (PD201404362)

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