RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2017-01959
BRANCH OF SERVICE:  Army	SEPARATION DATE:  20090413

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects this covered individual (CI) was a Reserve E5, Human Resource Specialist, medically separated for “bilateral patellofemoral pain syndrome” with a disability rating of 20%.  

CI CONTENTION:  “Both knees have gotten progressively worse…problems with instability.  Bilateral Plantar fasciitis.  Hypertension has gotten worse.  Insomnia has major affect on daily life.”  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 - 20090318	VARD - 20090923	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Bilateral Patellofemoral Pain Syndrome	5099-5003	20%	Patellofemoral Syndrome, Left Knee w/ Degenerative Changes	5260-5010	10%	20090521	
			Patellofemoral Syndrome, Right Knee	5099-5024	10%	20090521	
Plantar Fasciitis, Bilateral	Not Unfitting	Bilateral Plantar Fasciitis	5276	0%	20090521	
Hypertension,	Not Unfitting	Hypertension	7101	0%	20090521	
Sleep Disorder, Insomnia	Not Unfitting	Sleep Apnea	6847	NSC	20090521	
COMBINED RATING:  20%	COMBINED RATING OF ALL VA CONDITIONS:  20% 	

ANALYSIS SUMMARY:  

Bilateral Patellofemoral Pain Syndrome.  According to the service treatment record and MEB narrative summary (NARSUM), the CI’s left knee condition began in 2003 after jumping from a truck.  The right knee condition began shortly after with no specific injury, possibly due to compensation for the left knee.  X-rays and MRIs in June 2008 documented degenerative changes and chondromalacia in both knees.  

During the primary care clinic (PCC) appointment on 15 October 2008, 6 months prior to separation, the examiner noted that “motion was normal” for both knees, but also noted crepitus on motion and positive patellofemoral apprehension tests for both.  Neither knee demonstrated instability.  At the time of the PCC appointment on 10 December 2008, 4 months prior to separation, the examiner recorded that “knee motion was normal,” but that pain was elicited by motion in both knees.  

The 12 January 2009 MEB NARSUM examination, 3 months prior to separation, noted complaints of chronic bilateral knee pain.  Physical examination showed patellar grind with pain for both knees.  However, the examiner noted both knees appeared normal, with stable ligaments, negative drawer tests and stable varus and valgus stress.  On examination, the left/right knee range of motion (ROM) following repetitive movement was flexion of 115/119 degrees (normal 140) and extension of 0/0 degrees (normal 0) with painful motion.  

At the 21 May 2009 VA Compensation and Pension (C&P) evaluation, 1 month after separation, the CI reported constant bilateral knee pain, exacerbated by prolonged standing, walking, climbing stairs or prolonged sitting.  Physical examination showed both knees were tender to palpation and there was bilateral crepitus.  The left/right knee ROM was flexion of 130/130 degrees (normal 140) and extension of 0/0 degrees (normal 0) without pain.  Repetitive testing showed no additional loss of motion due to pain, fatigue, weakness, incoordination, or lack of endurance.  Lachman test, anterior and posterior drawer test, and varus and valgus stress revealed no laxity or instability in either knee.  McMurray test (for meniscal symptoms) was negative bilaterally.  X-rays showed tibial exostosis of both knees.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the bilateral knee condition as 20% specifically noting 10% for the right knee and 10% for the left knee, analogously coded as 5003 (arthritis, degenerative), citing ROM limited by pain.  The VA rated the left knee condition 10%, dual coded 5260-5010 (leg, limitation of flexion of - arthritis, due to trauma), based on the C&P examination, citing X-ray evidence of degenerative changes with limited or painful motion of a major joint.  The VA rated the right knee condition 10%, analogously coded 5099-5024 (tenosynovitis), citing limited or painful motion of a major joint.  

As each knee was unfitting and rated separately by the PEB, the panel considered its rating recommendation for each knee at the time of separation.  Each knee exam was similar and the ratings are therefore the same for each knee.  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 §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 higher rating than 10% for each knee (combined 20% as adjudicated by the PEB) available under any applicable VASRD codes.  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 Conditions:  Plantar Fasciitis; Hypertension; Sleep Disorder, Insomnia.  The panel’s main charge is to assess the fairness of the PEB determination that the contended conditions were not unfitting.  Although the plantar fasciitis was profiled with the knees, it was specified as L-2, and none of the other conditions were profiled.  None of the conditions were implicated in the commander’s statement or judged to fail retention standards.  There was no performance-based evidence from the record that any of the conditions 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 any of the contended conditions, so no additional disability ratings are recommended.  

BOARD FINDINGS:  In the matter of the bilateral knee condition and IAW VASRD §4.71a, the panel recommends no change in the PEB adjudication.  In the matter of the contended plantar fasciitis, hypertension, and sleep disorder conditions, the panel recommends no change from the PEB determinations 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.  

AR20180011264, 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.