RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXX 	CASE:  PD-2016-00796
BRANCH OF SERVICE:  Air Force 	SEPARATION DATE:  20040420

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E4, Traffic Management Journeyman, medically separated for bilateral “patellofemoral syndrome” with a disability rating of 10%.  

CI CONTENTION:  “Review all conditions.”  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 - 20040224	VARD - NA	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Patellofemoral Syndrome (PFS)	5003-5299	10%	No VA Examination Proximate to Separation	
	COMBINED RATING OF ALL VA CONDITIONS:  NA	

ANALYSIS SUMMARY:  

Patellofemoral Syndrome.  The PEB rated the bilateral patellofemoral pain syndrome (PFS) as a single unfitting condition analogously coded 5003-5299 (arthritis, degenerative) and rated 10%. The approach by the PEB not uncommonly reflected its judgment that the constellation of conditions was unfitting, and there was no need for separate fitness adjudications or implied adjudication that each condition was separately unfitting.  The panel also noted that “bundling,” the combining of two or more major joints, may be permissible under the VASRD 5003 rating requirements, and that this approach does not compromise the VASRD §4.7 directive to choose the higher of two valid ratings.  The panel’s initial charge in this case was therefore directed at determining if the PEB’s approach of combining conditions under a single rating was justified in lieu of separate ratings.  When considering a separate rating for each condition, the panel considers each bundled condition to be reasonably justified as separately unfitting unless a preponderance of evidence indicates the condition would not cause the member to be referred into the DES or be found unfit because of physical disability.  When the panel recommends separate fitness recommendations in this circumstance, its recommendations may not produce a lower combined rating than that of the PEB.  

According to the service treatment record (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s right knee condition began in 1999 without specific trauma or direct injury.  Despite medications, duty limitations, and physical therapy, the pain persisted.  In January 2000, an MRI was normal. On 14 February 2003, a CT scan showed bilateral tilting, but arthritic changes were not recorded.  Surgical intervention was not recommended.

At the 26 January 2004, MEB NARSUM examination, 3 months prior to separation, the CI reported ongoing anterior knee pain despite physical therapy, bilateral braces, medication, and modified activities.  Physical examination showed a normal gait and patellar tracking, no effusion or meniscal irritation, stable ligaments, and tenderness over the kneecaps bilaterally.  Range of motion testing was not documented in the STR.  The CI was diagnosed with bilateral PFS.  There was no VA examination in evidence proximate to separation.  

The panel first considered whether each knee was separately unfitting.  Both conditions were treated and the CI failed retention standards for bilateral knee pain, and so members agreed the evidence supported a finding that each knee was separately unfitting at separation.  The panel then directed attention to its rating recommendation based on the above evidence.  Painful motion was implied on multiple examinations, but limitation of motion was not documented.  Neither instability, meniscal pathology nor incapacitation was documented.  The PEB rated the bilateral patellofemoral syndrome condition 10%, coded 5003-5299.  A 10% rating under the provisions of 5003 is supported for painful motion (implied) and X-ray involvement of 2 or more major joints absent incapacitation.  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 bilateral PFS condition.  

BOARD FINDINGS:  In the matter of the bilateral patellofemoral condition and IAW VASRD §4.71a, the panel unanimously recommends no change in the PEB adjudication.  There are no other conditions within the panel’s scope of review for consideration.  The panel, therefore, recommends there be no modification or re-characterization of the CI’s disability and separation determination.  

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20160914, 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

XXXXXXXXXXXXXXXXXXX

Dear XXXXXXXXXXXXXXXXXXX:

Reference your application submitted under the provisions of DoDI 6040.44 (Section 1554, 10 USC), PDBR Case Number PD-2016-00796.

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. The Board recommended no re-characterization or modification of your separation.

I 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.  I accept their recommendation that your application be denied.

Sincerely,

Attachment:
Record of Proceedings