RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2017-01791
BRANCH OF SERVICE:  Air Force 	SEPARATION DATE:  20061016

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E5, Security Forces Journeyman, medically separated for “chronic right knee pain due to 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 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 - 20060828	VARD - 20070418	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Right Knee Pain due to Patellofemoral Syndrome	5099-5003	10%	Right Knee Patellofemoral Syndrome	5299-5260	0%	20070328	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  0%	

ANALYSIS SUMMARY:  

Chronic Right Knee Pain due to Patellofemoral Syndrome.  According to the service treatment record and MEB narrative summary (NARSUM), the CI had the chronic right knee pain condition for some time without a history of trauma or injury.  Physical therapy was ongoing since 2003 without significant results.  An orthopedic specialist diagnosed refractory right knee patellar tendinitis.  Surgery was recommended, but the CI declined. 

The 28 June 2006 MEB NARSUM examination, 4 months prior to separation, noted complaints of knee pain with carrying weight and standing for long periods.  Physical examination showed full range of motion (ROM) and no ligamentous instability.  There was pain on motion during ROM testing.  Muscle strength was 5/5 and deep tendon reflexes were 2+.  MRI and X-ray studies were unremarkable.  At the 28 March 2007 VA Compensation and Pension (C&P) evaluation, 5 months after separation, the CI reported varying levels of pain related to the intensity of activity.  She had knee pain with going up and down stairs.  Physical examination noted normal flexion and extension with no pain.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the chronic right knee pain condition 10%, analogously coded 5099-5003 (arthritis, degenerative), citing the condition prevented the performance of duties.  The VA rated the right knee patellofemoral syndrome 0%, analogously coded 5299-5260 (leg, limitation of flexion), based on the C&P 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) to support a rating under the respective codes.  There was no fracture, nonunion, 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 were no additional codes to consider.  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 chronic right knee pain due to patellofemoral syndrome.  

BOARD FINDINGS:  In the matter of the chronic right knee pain due to patellofemoral syndrome condition and IAW VASRD §4.71, 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 20170228, 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-2017-01791.

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