RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2017-01450
BRANCH OF SERVICE:  Air Force 	SEPARATION DATE:  20050504

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E5, Vehicle Operations Apprentice, medically separated for “chronic left patellar tendonitis” with a disability rating of 10%.  

CI CONTENTION:  “I received 2 unsuccessful surgeries by the USAF.  I am currently on permanent work schedule for my left knee.”  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 FPEB - 20050211	VARD - 20060202	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Left Patellar Tendonitis 	5024-5003	10%	Left Patellofemoral Syndrome S/P Surgery X2	5260	10%	20051208	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  30%	

ANALYSIS SUMMARY:  

Chronic Left Patellar Tendonitis.  According to the service treatment record and MEB narrative summary (NARSUM), the CI’s left patellar tendonitis condition began in February 1998 subsequent to right patellar tendonitis.  Treatment consisted of a diagnostic injection in April 1998 followed by physical therapy.  Excision of left patellar tendonosis was performed in November 1998 with subsequent physical therapy.  The CI had persistent patellar tendonitis and underwent left patellar debridement in 2000.  The CI had additional orthopedic evaluations and a normal MRI of the left knee in January 2002 with the exception of minimal changes at the inferior patellar junction with the superior patellar ligament which could have represented mild localized inflammation seen with repetitive stress injury.  Plain films of the left knee in March 2002 were normal as well.  On 4 May 2004 the CI reported pain with sleep, sitting long periods, and with exercise.  An MRI dated 14 June 2004 demonstrated no significant findings.  At an orthopedic clinic visit on 21 June 2004 the CI complained of longstanding activity related left anterior knee pain.  Examination revealed a well-healed anterior midline incision with minimal tenderness of the inferior patella pole.  The range of motion (ROM) was full and quadriceps strength was normal.  Ligaments were intact and there was no patellofemoral crepitus (grinding sensation) and a negative grind test.  The examiner’s diagnosis was left patellar tendonitis refractory to surgical debridement times two.  Surgery was not recommended.  X-rays were normal.  

The undated MEB NARSUM examination noted the CI’s complaint of chronic knee pain.  After two surgical procedures on the left knee, he had an MEB and was cross-trained to a new AFSC (Vehicle Operations) and had been in that field since 8 April 2004.  Physical examination showed no obvious deformity of the left knee with no effusion, ecchymosis, erythema, or edema.  There was mild tenderness at the left anterior knee.  The ROM was full without crepitus (grinding sensation).  There was no laxity of the knee and no evidence of a meniscal tear.  Musculoskeletal strength was normal as was his gait.  Distally, he was neurovascularly intact.  The examiner noted the CI had chronic knee pain non-responsive to physical therapy and medication.  Specialty evaluation and surgical intervention did not result in decreasing the CI’s pain and cross-training did not result in a reduction of symptoms.  

On 22 February 2005 while undergoing an MEB, the CI reported his symptoms were quiescent with no pain, swelling, giving out, or locking.  He was able to stand for an extended period of time and squat without any problems.  Examination of the left knee revealed no obvious deformity except for a surgical scar.  There was full ROM without crepitus and no joint line tenderness.  Muscle strength was normal and there was no laxity or evidence of a meniscal tear.  

At the 12 December 2005 VA Compensation and Pension (C&P) examination, 7 months after separation, the CI reported pain in the left knee more than the right when going uphill.  He had some stiffness, but reported no swelling, heat, redness, instability, locking, fatigability, or flare-ups. He used no corrective shoes, braces, or cane.  Physical examination showed the left knee ROM was 0-102 degrees with no pain or functional impairment following repetitive use.  There was no edema, effusion, instability, weakness, tenderness, redness, heat, abdominal movement, or guarding.  Gait was normal.  There was no ankylosis, inflammatory arthritis, or prosthesis.  The examiner’s diagnosis was left patellofemoral syndrome secondary to patella alta, operated.  X-rays of both knees dated 9 December 2005 demonstrated no significant bone or soft tissue abnormality

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the chronic left patellar tendonitis 10%, coded 5024-5003 (tenosynovitis-arthritis, degenerative).  The VA also rated the left patellofemoral condition 10%, coded 5260 (leg, limitation of flexion) based on the C&P examination, citing slight limitation of flexion.  

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 history of surgery to remove a meniscus (5259), to support a rating under the 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 rating option higher than the 10% adjudicated by the PEB under any applicable code.  After due deliberation, considering all 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 left patellar tendonitis condition.  

BOARD FINDINGS:  In the matter of the left patellar tendonitis condition and IAW VASRD §4.71a, the panel recommends no change in the PEB adjudication.  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 20170226, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs 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-2017-01450.

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