RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXXXX	CASE:  PD-2015-00146
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20090519

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E6, Abrams Tank System Maintainer, medically separated for “bilateral patellofemoral syndrome” and “right knee pain,” rated 10% for the right and 10% for the left, respectively, with a combined disability rating of 20%.  

CI CONTENTION:  All conditions are requested.  His 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 - 20090202	VA - 20100202	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Bilateral Patellofemoral Syndrome	5099-5003	10%	Patellofemoral Pain Syndrome Right Knee with Arthritis	5260	10%	20090617
20091210	
		10%	Patellofemoral Pain Syndrome, Left Knee with Arthritis	5260	10%		
COMBINED RATING:  20%	COMBINED RATING:  30%	

ANALYSIS SUMMARY:  

Bilateral Patellofemoral Syndrome.  According to service treatment records and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s bilateral knee condition began in 2006 with no history of trauma.  Radiographic evaluation in March 2008 documented no effusion, no fractures, and patellar tendon calcifications likely due to prior injury.  All notes in evidence documented tenderness about the patella.  There was intermittent documentation of bilateral crepitus and antalgic gaits.  Full range of motion (ROM) was documented at four separate visits in October 2007, March, August and December 2008.  Despite treatment, the bilateral knee condition could not be adequately rehabilitated to meet the physical requirements of the CI’s military specialty and he was referred for an MEB.  The MEB forwarded “bilateral patellofemoral syndrome” for PEB adjudication.  

At the December 2008 MEB examination (documented on DD Forms 2807-1 and 2808), 5 months pre-separation, the CI reported constant knee pain and use of knee braces.  The physical examination showed full ROM with bilateral medial joint line tenderness, bilateral crepitus (right greater than left), and no evidence of anterior or posterior laxity.  At the 15 December 2008 MEB NARSUM examination, the CI reported pain behind the knee cap and deep within the knee when walking up or down stairs, sitting for prolonged periods of time, and kneeling.  The physical examination showed full ROM bilaterally, with bilateral crepitus and patellar grind.  There was no evidence of instability, effusions, or abnormal patellar tracking.  

At the VA Compensation and Pension (C&P) examination dated 17 June 2009 (1 month post-separation), the CI reported wearing braces, and denied locking, dislocation, swelling, or periods of incapacitation.  No physical examination was documented.  At another C&P examination in December 2009, 7 months post-separation, the physical examination documented a bilateral knee flexion to 140 degrees (normal), and hyperextension of 10 degrees (normal 0); both with evidence of painful motion.  There was no evidence of ligamentous laxity or meniscal injury.  There was no additional limitation of motion after repetition.  

The Board directed attention to the rating recommendation based on the above evidence.  The PEB rated 10% for the right and 10% for the left knee condition, analogously coded 5099-5003 (degenerative arthritis), citing full ROM, painful motion, and crepitus bilaterally.  The VA also individually rated each knee condition at 10%, coded 5260 (leg, limitation of flexion), based on the June and December 2009 C&P post-separation examinations, citing painful motion.  

The Board considered the evidence for rating.  There was evidence of painful motion with functional loss supporting a 10% rating for each knee (based on §4.59, §4.40 and §4.45) as adjudicated by the PEB. There was no limitation of motion which supported a higher rating under the diagnostic codes for limitation of flexion or extension (5260, 5261).  There was no evidence of frequent episodes of locking, pain, and effusion into the joint for coding under 5258 and no evidence of moderate recurrent sub luxation or lateral instability for higher coding under 5257 (knee, other impairment of).  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 knee patellofemoral syndrome.  

BOARD FINDINGS:  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.  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 20141229, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

SAMR-RB						

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 XXXXXXXXXXXXXXXXXXXXX, AR20170002537 (PD201500146)

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