RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2017-00893
BRANCH OF SERVICE:  army 	SEPARATION DATE:  20090812

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E4, Wheeled Vehicle Mechanic, medically separated for “bilateral patellofemoral syndrome,” rated 10% each knee, with a combined disability rating of 20%. 

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 Medical Evaluation Board (MEB), but determined by the PEB 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.  The panel’s authority is limited to assessing the fairness and accuracy of PEB rating determinations and recommending corrections when appropriate.  The panel’s assessment of the PEB rating determination is based on review of medical records and all available evidence relevant to application of the Veterans Affairs Schedule for Rating Disabilities (VASRD) standards for 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, which operates 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 disability at the time of separation.  

RATING COMPARISON:  

SERVICE PEB - 20090515	VARD - 20090925	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Bilateral Patellofemoral Syndrome	5099-5003 	10% 	Patellofemoral Syndrome Left Knee	5260	10%	20090814	
		10%	Patellofemoral Syndrome Right Knee	5260	10%	20090814	
Bilateral Pes Planus	Not Unfitting	Bilateral Flat Feet	5276	NSC	20090814	
COMBINED RATING:  20%	COMBINED RATING OF ALL VA CONDITIONS:  20%	

ANALYSIS SUMMARY:  

Bilateral Patellofemoral Syndrome (PFS).  According to the service treatment record and MEB narrative summary (NARSUM), the CI developed anterior leg pain in November 2007 during basic training.  Bilateral leg x-rays were normal, but a 20 November 2008 bone scan showed changes consistent with bilateral shin splints.  Treatment visits indicated working diagnoses of shin splints, limb pain, and pain in the leg below the knee.  Orthopedic evaluation found no evidence of exercise induced compartment syndrome and confirmed the diagnosis of shin splints.  

The 27 February 2009 permanent profile listed shin splints.  The 7 April 2009 commander’s statement did not mention a specific medical condition, noting the CI was able to perform duties as a mechanic, but was unable to run, walk, or march.  The commander recommended that the CI be retrained and retained in the Army.  

The 25 March 2009 MEB NARSUM examination, 5 months prior to separation, noted complaints of “disabling pain in both anterior leg muscles…accentuated by any high impact activity such as running, jumping, climbing, lifting, and marching long distances over rough and irregular terrain.”  Prolonged standing also aggravated the condition.  Physical examination showed a normal gait.  There was tenderness over the anterior tibial muscle group of both legs.  Lower extremity reflexes and sensation were normal.  The examiner indicated the CI did not meet retention standards due to the bilateral shin splints condition.  

At the 14 August 2009 VA Compensation and Pension (C&P) examination, 2 days after separation, the CI reported being diagnosed with bilateral PFS.  He reported weakness, stiffness, swelling, and tenderness, but denied heat, redness, giving way, lack of endurance, locking, fatigability, deformity, drainage, effusion, subluxation, pain, or dislocation.  He reported pain with movement and difficulty running.  He was not receiving treatment for the condition and he denied any incapacitation due to the condition.  Physical examination showed guarding of movement of both knees, without edema, instability, abnormal movement, effusion, weakness, tenderness, malalignment, or subluxation.  There was no crepitus, locking pain, or recurvatum of either knee.  Bilateral knee ROM was 140 degrees flexion (normal 140) and 0 degrees extension (normal 0).  There was no pain with motion and no additional loss of ROM with repetition.  Bilateral X-rays of the legs and knees were normal.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the bilateral knee conditions 10% on the left and 10% on the right, coded 5099-5003 (analogous to degenerative arthritis), citing evaluation of bilateral patellofemoral syndrome as degenerative arthritis with satisfactory evidence of painful motion.  The VA also rated the bilateral knee conditions (also diagnosed as patellofemoral syndrome) 10% on the left and 10% on the right, both coded 5260 (limitation of leg flexion), based on the C&P examination, citing painful motion.

The panel noted that there was no diagnosis of PFS of either knee documented in the treatment record.  The PEB adjudicated bilateral PFS, but also remarked that the bone scan was consistent with shin splints and there was tenderness to palpation of the anterior leg muscles.  Therefore, the panel considered all possible ratings for the knee and/or leg below the knee, excluding the ankle and foot.  

There was no evidence of painful motion with functional loss supporting a 10% rating (based on §4.59, §4.40 and §4.45).  There likewise was no limitation of knee motion which attained a 10% rating under the diagnostic codes for limitation of flexion or extension (5260, 5261).  There was no history or evidence 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 codes.  There was no evidence of limited motion of the knees or arthritis of the knee joints for a 10% rating under 5003 and related codes.  However, a 10% rating was supportable for each limb, coded analogously 5299-5262 (tibial or fibula impairment), an analogous code for shin splints, which was the bilateral leg pain diagnosis in the STR.  There was no higher than a 10% rating available for either lower extremity with any applicable VASRD code.  Therefore, although the panel utilized a different code than the PEB, this approach provided no ratings benefit to the CI.  Therefore, no change to the PEB’s coding choice is recommended.  After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the panel concluded there was insufficient cause to recommend a change in the PEB adjudication for the bilateral knee condition.  
Contended PEB Condition:  Bilateral Pes Planus.  The panel’s main charge is to assess the fairness of the PEB’s determination that the contended condition was not unfitting.  The contended condition was not profiled, implicated in the commander’s statement, nor judged to fail retention standards.  There was no performance-based evidence from the record that the condition significantly interfered with satisfactory duty performance at separation.  After due deliberation, the panel concluded there was insufficient cause to recommend a change in the PEB fitness determination for the contended condition, so no additional disability rating is recommended.  

BOARD FINDINGS:  In the matter of the bilateral patellofemoral syndrome and IAW VASRD §4.71a, the panel recommends no change in the PEB adjudication.  In the matter of the contended bilateral pes planus condition, the panel recommends no change from the PEB determination as not unfitting.  There are no other conditions within the panel’s scope of review for consideration.  Therefore, the panel recommends 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 20170223, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Record 

AR20180004950, XXXXXXXXXXXXXXXXXX

XXXXXXXXXXXXXXXXXX

Dear XXXXXXXXXXXXXXXXXX:

	The Department of Defense Physical Disability Board of Review (DoD PDBR) reviewed your application and found your separation disability rating and your separation from the Army for disability with severance pay to be accurate.  I have reviewed the Board’s recommendation and record of proceedings (copy enclosed), and I accept its recommendation.  I regret to inform you that your application to the DoD PDBR is denied.  

	This decision is final.  Recourse within the Department of Defense or the Department of the Army is exhausted; however, you have the option to seek relief by filing suit in a court of appropriate jurisdiction.

Sincerely,					      
Enclosure