RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXXXX	CASE:  PD-2015-00967
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20091024

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E4, Watercraft Engineer, medically separated for “chronic [right] patellofemoral pain syndrome” and “chronic [left] patellofemoral pain syndrome,” rated 10% and 10% respectively, with a combined disability rating of 20%. 

CI CONTENTION:  The CI contends that his bilateral knee condition has affected many aspects of his life and should be changed to a higher rating.  He would also like to have all of his medical conditions reviewed.  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 - 20090813	VARD - None	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic [Right] Patellofemoral Pain Syndrome	5099-5003	10%	No VA evaluation 	
Chronic [Left] Patellofemoral Pain Syndrome	5099-5003	10%		
COMBINED RATING:  20%	COMBINED RATING OF ALL VA CONDITIONS:  NA	

ANALYSIS SUMMARY:  

Chronic Bilateral Patellofemoral Pain Syndrome.  According to service treatment records and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI first noted bilateral knee pain during basic training in April 2007.  He denied any specific injury or trauma.  Radiographic studies were normal showing no arthritis or structural abnormalities.  There was no surgical indication, and conservative treatment including medications, duty restrictions, and physical therapy (PT) did not result in improvement sufficient to allow unrestricted duty.  X-rays and MRIs of each knee were noted to be essentially normal.  The MEB forwarded “chronic bilateral patellofemoral pain syndrome” for PEB adjudication.  
At the time of the PT clinic MEB range of motion (ROM) examination on 19 May 2009, 5 months prior to separation, the CI had decreased ROM.  The examiner noted that the CI had bilateral patellar knee pain with full knee extension.  There was no tenderness and the CI did not have an antalgic gait.  Examination testing for ligamentous instability was negative bilaterally.  No comment was made on meniscal (an internal cartilage cushion) signs.  During the 12 June 2009 MEB examination (recorded on DD Forms 2807 and 2808), 4 months prior to separation, the CI reported that his bilateral knees had become swollen from running and overuse.  He also reported that he occasionally had his knee joint slip out of place and that if he stood for too long, he couldn’t bend his knee and if he bent his knee for too long he couldn’t straighten it.  However, the CI did not specify which knee was affected.  The physical examination was normal for his bilateral lower extremities.  

At the MEB NARSUM examination, 26 June 2009, 4 months prior to separation, the CI reported left greater than right knee pain.  The physical examination noted full ROM of both knees; there was no mention of painful motion.  There was no effusion or pain with patellar (kneecap) compression, but the CI had mild tenderness over the patellar tendon.  The remainder of the knee examination was noted to be normal, implying that the knees were stable and without signs of meniscal irritation.  At the time of the 7 August 2009 PT clinic MEB ROM examination, 3 months prior to separation, the CI had decreased ROM with bilateral knee pain elicited at the extreme limits of the ROM.  The examiner noted that in addition to painful motion, the CI also was guarding his knee movements during the examination.  Examination tests for ligamentous instability were negative bilaterally.  There was no VA examination in evidence nor were there records indicating that he sought VA compensation.  

The Board directed attention to its rating recommendation based on the above evidence.  The Informal PEB initially rated the knees at 0%, but the Formal PEB increased the rating to 10% for each knee condition, coded 5099-5003 (analogous to degenerative arthritis), citing painful motion.  The limitation of motion code for extension (5261) was applicable in this case and the limitation of extension noted on the second PT ROM examination only warranted a 10% rating for the right knee and 20% for the left.  However, examinations before and after this single examination showed normal extension and support 0% ratings.  The flexion limitations were not compensable and provided no benefit to the CI.  Instability was not present and signs of meniscal irritation were absent.  Painful motion supports a 10% rating for each knee.  The preponderance of evidence supports the 10% adjudicated for each knee by the PEB, and there are no grounds for additional rating for either knee based on the presence of instability.  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 condition.  

BOARD FINDINGS:  In the matter of the bilateral 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.  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 20150608, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

SAMR-RB

MEMORANDUM FOR 

SUBJECT: Department of Defense Physical Disability Board of Review Recommendation
for XXXXXXXXXXXXXXXXXXXXX, AR20170000900 (PD201500967)

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.

Enclosure
CF:
( ) DoD PDBR
( ) DVA