RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME: XXXXXXXXXXXXXXXXXX	CASE:  PD-2015-02289
BRANCH OF SERVICE:  Air Force 	SEPARATION DATE:  20040628

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E1, Security Forces Helper Trainee, medically separated for “left knee patellofemoral syndrome,” with a disability rating of 10%.  

CI CONTENTION:  The CI made no specific contention.  Her 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 - 20040309	VARD - 20041105	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Left Knee Patellofemoral Syndrome	5003-5299	10%	Left Knee Patellofemoral Syndrome	5024	NSC	N/A	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  NA	

ANALYSIS SUMMARY:  
Left Knee Patellofemoral Syndrome.  According to service treatment records (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s left knee condition began in September 2003 with a hyperflexion injury.  Radiographic studies were normal and magnetic resonance imaging (MRI) studies showed bone bruises of the lateral femoral condyle and a probable small lymph node.  Despite treatment, the left knee condition could not be adequately rehabilitated to meet the physical requirements of the CI’s military specialty and she was referred for an MEB.  The MEB forwarded “left patellofemoral pain syndrome” for PEB adjudication.  

At the time of the orthopedic clinic appointment on 1 October 2003, the CI reported a 2-week history of left knee pain.  She had her right knee forward and flexed and the left knee extended posteriorly when she heard a “pop” in her left knee and fell back with a hyperflexion injury. Physical examination revealed 3+ effusion. There was a negative patellar grind and apprehension, stable to varus/valgus, negative McMurray test, 1A Lachman anterior drawer and normal motor strength.  Range of motion (ROM) showed a flexion of 130 degrees (normal 140) and an extension of 5 degrees (normal 0).  At the time of the orthopedic clinic appointment on 29 October 2003, physical examination showed no edema, no ecchymosis and no effusion.  ROM measurements again showed flexion of 130 degrees and extension of 5 degrees.  There was tenderness to palpation, no patellar grind; stable to varus/valgus, negative drawer, and negative McMurray.  At the time of the orthopedic clinic appointment on 7 January 2004, 6 months before separation, the CI complained of pain after running.  Physical examination showed ROM measurements of flexion of 130 degrees and a normal extension without pain.  There was tenderness to palpation, positive patellar grind and apprehension.  Strength was normal, stable to varus/valgus, and negative anterior/posterior drawer, Lachman’s, and McMurray’s tests.  The MEB NARSUM noted the physical examination was completely normal except for a positive patellar grind on the left knee.  The CI failed to report for the scheduled VA Compensation and Pension evaluation.  

The Board directed attention to its rating recommendation based on the above evidence.  The PEB rated the left knee condition 10%, analogously coded 5003-5299 (arthritis, degenerative).  The VA denied service connection for the left knee patellofemoral syndrome citing no evidence, unavailability of STR, and failure of the CI to report for the VA examination.  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) as adjudicated by the PEB. 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 a 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).  There was therefore no VASRD §4.71a route to a rating higher than the 10% adjudicated by the PEB under any applicable code, and no grounds for additional rating 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 patellofemoral syndrome, left knee condition.  

BOARD FINDINGS:  In the matter of the left knee 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 20150827, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

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

Dear XXXXXXXXXX:

Reference your application submitted under the provisions of DoDI 6040.44 (Section 1554, 10 USC), PDBR Case Number PD-2015-02289.

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,

Attachment:
Record of Proceedings