RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXXX	CASE:  PD-2017-02426
BRANCH OF SERVICE:  Army	SEPARATION DATE:  20091019

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

CI CONTENTION:  No specific contention was 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 - 20090713	VARD - 20100521	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Bilateral PFPS Syndrome	5009-5003	10%	PFPS with Pes Anserine, Left Knee	5299-5261	0%	20100121	
		10%	PFPS with Pes Anserine, Right Knee	5299-5261	0%	20100121	
COMBINED RATING:  20%	COMBINED RATING OF ALL VA CONDITIONS:  50%	

ANALYSIS SUMMARY:  

Bilateral PFPS.  According to the service treatment record and MEB narrative summary (NARSUM), the CI’s bilateral knee condition began in February 2007 when his HUMVEE was struck by an IED and the CI was thrown forward hitting his knees.  The CI completed his tour in Iraq in January 2008.  Bilateral knee X-rays on 16 September 2008 revealed mild degenerative changes and were otherwise unremarkable.  Bone scan on 8 January 2009 showed bilateral increased activity in the areas of the knees.  Left knee MRI on 29 October 2009 was normal.  

During the 12 May 2009 MEB examination (recorded on DD Forms 2807-1 and 2808), 5 months prior to separation, the CI reported knee pain in both knees when he ran, stood, rode a bike or ruck marched.  Physical therapy did not help symptoms.  Physical examination revealed a normal gait.  There was tenderness over the right and left anserine bursa.  There were no signs of swelling or edema.  Range of motion (ROM) was flexion of 135 degrees (140 normal) on both the right and left knee with “normal extension”.  The CI had a negative Lachman’s, anterior-posterior drawer sign, McMurray, pivot shift test and negative varus valgus instability testing with only minimal discomfort on the patellar apprehension or grind test.  All testing was bilateral.  The 8 June 2009 MEB NARSUM examination, 4 months prior to separation, noted complaints of pain in both knees all the time with severe pain (rated 6-7/10) with any type of prolonged ambulation, standing, sitting, running or jumping.  The examiner reported the physical examination finding from the 12 May 2009 MEB examination.  

At the 7 and 21 January 2010 VA Compensation and Pension (C&P) examinations, 3 months after separation, the CI reported his knees were sore after repetitive walking, running, standing or sitting.  Since separation he worked as a security guard.  Physical examination showed no effusion or joint line pain.  The first (general) examination showed bilateral knee crepitus.  The second (joints) examination showed ROM was 138 degrees flexion and 0 degrees extension actively.  Passive ROM was pain-free three times bilaterally.  Bilateral knee X-rays findings demonstrated maintenance of the joint spaces without degenerative changes or joint effusion; unremarkable bilateral knees.  The examiner stated “I would expect a loss of between 10 and 15 degrees on his overall ROM, strength, coordination, and fatigability associated with repetitive movement flares.”  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated each knee 10%, analogously coded 5099-5003 (degenerative arthritis), citing satisfactory evidence of pain with use.  The VA rated each knee 0%, analogously coded 5299-5261 (leg, limitation of extension) based on the C&P examination, citing an evaluation of 10% is not warranted unless flexion is limited to 45 degrees or extension is limited to 10 degrees.  The VA also rated each leg condition 0% analogously coded 5299-5262 (tibia and fibula, impairment), citing the absence of slight knee or ankle disability.  

There was no limitation of motion which supported a rating under the diagnostic codes for limitation of flexion or extension (5260, 5261) for either knee.  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 rating under any applicable coding higher than the 10% for each knee as adjudicated by the PEB.  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 bilateral knee condition.  

BOARD FINDINGS:  In the matter of the bilateral patellofemoral pain syndrome 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 20170403, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Record 

AR20190011716, 

Dear XXXXXXXXXXXXXXXX:

	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