RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX.	CASE:  PD-2015-01103
BRANCH OF SERVICE:  air force	SEPARATION DATE:  20050923

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E3, Electrical Systems Journeyman, medically separated for “patellofemoral syndrome, left knee” rated 10%. 

CI CONTENTION:  The CI contends his unfitting condition continues to negatively affect his life.  The complete submission is at Exhibit A.  

SCOPE OF REVIEW:  The panel’s scope of review is defined in DoDI 6040.44.  It is limited to review of disability ratings assigned 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 or non-compensable.  Any conditions outside the panel’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 panel’s authority is limited to assessing the fairness and accuracy of PEB rating determinations and recommending corrections, where appropriate.  The panel’s assessment of the PEB rating determination 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(s) at the time of separation.  The panel 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 panel 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 - 20050803	VARD - 20060330	
Condition	Code	Rating	Condition	Code	Rating	Exam	
PFS, Left Knee	5099-5003	10%	PFPS, Left Knee	5299-5024	0%	20060309	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  0%	

ANALYSIS SUMMARY:  

Patellofemoral Syndrome, Left Knee.  According to service treatment records (STRs) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s left knee condition began in June 2004 after falling.  Despite conservative treatment, the left knee condition could not be adequately rehabilitated to meet the physical requirements of the CI’s military specialty and the CI was referred for an MEB.  The MEB forwarded “left patellofemoral syndrome” for PEB adjudication.

The 2 May 2005 MEB NARSUM examination, 4 months prior to separation, noted complaints of chronic daily pain with prolonged standing, climbing, or running.  Physical examination showed full range of motion (ROM; 0-140 normal) with tenderness of the knee.  There was no effusion (fluid buildup in the joint), deformity, or dislocation noted.  The knee exhibited normal strength with no signs of instability.  The examiner noted the CI had such severe left knee pain that it limited him from doing his job, and that he was unable to perform any physical activities.  The examiner concluded that surgery would likely not give relief the CI desired.

 At the 9 March 2006 VA Compensation and Pension (C&P) evaluation, performed 6 months after separation, the CI reported ongoing pain, rated 6/10 in severity, exacerbated by walking, increased activity, squatting and odd sitting positions, which was relieved  by avoiding those activities.  The CI worked as an overnight inventory stocker.  Physical examination revealed a normal gait, no tenderness of the knee, and no effusion or instability.  ROM was recorded as 0-140 degrees without pain. 

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the patellofemoral syndrome, left knee condition 10%, coded 5099-5003 (arthritis, degenerative), citing knee pain with full ROM.  The VA rated patellofemoral pain syndrome at 0%, coded 5299-5024 (analogous to tenosynovitis), based on the C&P examination 6 months after separation.  There was no limitation of motion which supported a rating under the diagnostic codes for limitation of flexion or extension (5260, 5261).  There was also no evidence of painful motion.  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 those 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).  Therefore, there was no VASRD §4.71a route to a rating higher than the 10% adjudicated by the PEB under any applicable code.  After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the panel concluded that there was insufficient cause to recommend a change in the PEB adjudication for the patellofemoral syndrome, left knee condition.  

PANEL FINDINGS:  In the matter of the patellofemoral syndrome, left knee condition and IAW VASRD §4.71a, the panel unanimously recommends no change in the PEB adjudication.  There were no other conditions within the panel’s scope of review for consideration.  

The panel, 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 20150605, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record 

SAF/MRB
1500 West Perimeter Road, Suite 3700
Joint Base Andrews, MD  20762

XXXXXXXXXXXXXXXXXX
Dear XXXXXXXXXXXXXXXXXX:

Reference your application submitted under the provisions of DoDI 6040.44 (Section 1554, 10 USC), PDBR Case Number PD-2015-01103.

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 appropriate.  Accordingly, the Board recommended no re-characterization or modification of your separation.

I have carefully reviewed the evidence of record and the recommendation of the Board.  I concur with that finding and their conclusion that re-characterization of your separation is not warranted.  Accordingly, I accept their recommendation that your application be denied.

Sincerely,

XXXXXXXXXXXXXXXXXX
Director
Air Force Review Boards Agency

Attachment:
Record of Proceedings