RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2017-01953
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20090506

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E6, Wheeled Vehicle Mechanic, medically separated for “left knee patellofemoral syndrome” and “right knee patellofemoral syndrome,” rated 10% each, with a combined disability rating of 20%.  

CI CONTENTION:  No specific contention made.  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 - 20090327	VARD - NA	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Left Knee Patellofemoral Syndrome	5099-5003	10%	No VA Examination Proximate to Separation in Evidence	
Right Knee Patellofemoral Syndrome	5099-5003	10%		
COMBINED RATING:  20%	COMBINED RATING OF ALL VA CONDITIONS:  NA	

ANALYSIS SUMMARY:  

Bilateral Patellofemoral Syndrome.  The CI was rated separately for his left and right knee patellofemoral syndrome; however, review of the service treatment record (STR) reveals that the symptoms and treatment for both knees were the same.  Therefore, in the interest of brevity the knees are presented together in this analysis, with separate recommendations for rating as appropriate.  

According to the STR and MEB narrative summary (NARSUM), dating back to his enlistment in 2000 the CI had bilateral knee problems which then became more severe and chronic after a deployment in 2004-2005.  He continued to serve with episodic pain, undergoing conventional treatment including physical therapy, electroshock therapy, duty limitations, and multiple medications including nonsteroidal anti-inflammatory medications, muscle relaxers, and analgesic narcotic medications.  

At the time of his orthopedic consultation on 17 December 2008, he reported his knee pain was so severe it caused insomnia and his knees were sore just sitting down.  X-rays taken that day were unremarkable except for an old healed fracture of the left patella but magnetic resonance imaging later showed there was never a fracture, but a bipartite patella, confirmed by orthopedics.  Physical examination showed normal knee motion, with no swelling, induration, edema, erythema, or painful motion.  Both knees were tender, with no laxity and negative McMurray and Lachman’s tests, no anterior or posterior drawer signs, and no demonstrated muscle weakness.  Diagnosis was patellofemoral syndrome.  Similar findings were rendered at the 27 January 2009 orthopedic clinic visit, with no patella tilt noted on the right knee but some tilt on the left.  

The 20 February 2009 MEB NARSUM reported findings from the 4 February 2009 MEB examination (reported on DD Forms 2807-1 and 2808), 3 months prior to separation, noting bilateral knee pain with a global intensity of 6/10, easily aggravated to an 8-9/10 with any strenuous activity including running, ruck marching, sudden rushes, climbing, stooping, or even wearing body armor.  Physical examination showed a normal gait.  There was no evidence of crepitus, deformity, effusion, erythema, or warmth bilaterally.  There was mild medial joint line tenderness to the right knee and medial and lateral joint line tenderness to the left knee.  All orthopedic knee tests were negative including posterior and anterior drawer signs and McMurray’s.  There was a questionable +1 Lachman bilaterally, although the examiner noted the CI seemed to be guarding somewhat during the maneuver.  Full range of motion (ROM) was noted with only minimal complaint of pain.  There was no VA examination proximate to separation in evidence.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the left knee condition 10% and the right knee condition 10%, both analogously coded 5099-5003 (degenerative arthritis), citing painful motion  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 for each knee (based on VASRD §§4.59, 4.40, and 4.45).  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 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 was therefore no VASRD §4.71a higher rating option for either knee 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 and right knee conditions.  

BOARD FINDINGS:  In the matter of the left knee and right knee conditions 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 20170302, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Record 

AR20180010646, 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