RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2017-02510
BRANCH OF SERVICE:  army	SEPARATION DATE:  20091207

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

CI CONTENTION.  Review requested of knees and additional conditions not identified by the Medical Evaluation Board (MEB) and Physical Evaluation Board (PEB).  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 PEB to be unfitting for continued military service, and when specifically requested by the CI, those conditions identified by the 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 - 20091113	VARD - 20100329	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Bilateral  [Right and Left] Patellofemoral Syndrome	5099-5003	10%	Right Knee Patellofemoral Chondromalacia	5260	10%	20100213	
		10%	Left Knee Patellofemoral Chondromalacia	5260	10%	20100213	
COMBINED RATING:  20%	COMBINED RATING OF ALL VA CONDITIONS:  70%	

ANALYSIS SUMMARY:

Bilateral Patellofemoral Syndrome.  According to the service treatment record (STR) and MEB narrative summary (NARSUM), the CI’s bilateral knee pain began in about March 2008 without specific trauma.  Knee X-rays on 2 May 2008 demonstrated minimal degenerative changes of the medial compartment of each knee.  At a primary care examination on 11 February 2009, the CI reported bilateral knee pain, and the provider recorded negative bilateral meniscus impairment testing and no evidence of laxity or instability; bilateral knee motion was “full” and elicited pain.  At a clinic visit on 17 March 2009, gait and active range of motion (ROM) was within normal limits, but testing additionally noted hamstring muscle tightness.  The examiner’s impression was bilateral knee pain/patellofemoral pain syndrome with mild osteoarthritis at the bilateral medial compartments.  During the 24 April 2009 MEB examination (recorded on DD Forms 2807-1 and 2808), 8 months before separation, the CI reported bilateral knee pain. The examiner noted no tenderness or weakness, and “normal” bilateral knee ROM with no painful motion.   

At an orthopedic examination on 14 July 2009, 5 months prior to separation, the CI complained of chronic bilateral knee pain.  Physical examination revealed negative bilateral meniscus impairment testing and “full” bilateral knee ROM, with no laxity or instability.  Knee X-rays showed some irregularity of the patellar undersurface, with the right knee patella laterally displaced on the sunrise view.  At the troop medical clinic on 12 August 2009, 4 months before separation, the CI reported bilateral retropatellar knee pain with a sensation of “squeezing and pressure.”  The examiner recorded negative meniscal impairment testing, no laxity or instability, and “full” bilateral knee ROM; painful motion was not addressed.  On the same day, MRIs revealed mild myxoid degeneration of the medial meniscus of both knees without evidence of a surface tear or internal derangement of either knee. The 23 September 2009 MEB NARSUM addendum examination, 3 month prior to separation, repeated findings from the 12 August 2009 visit, and  the examiner referenced knee ROM data that was completed on 11 September 2009, but not found in evidence. 

The 13 February 2010 VA Compensation and Pension (C&P) orthopedic examination, 2 months after separation, noted complaints of bilateral knee pain, but the CI did not use an assistive device, cane, or brace.  Physical examination revealed bilateral knee extension to 0 degrees (normal) and flexion to 123 degrees (normal 140), without painful motion.  There was no additional loss of ROM due to pain after repetition, and no instability, laxity, or evidence of a meniscal tear.  Right knee X-rays revealed well-maintained medial and lateral compartments, and no significant osteophyte formation.  Left knee X-rays showed no significant loss of joint space or osteophyte formation.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the bilateral knee condition 10% for each knee, coded 5099-5003 (arthritis, degenerative), citing painful motion with functional loss.  The VA rated each knee condition 10%, coded 5260 (leg, limitation of flexion), based on the C&P examination, citing pain and limited motion.  Although there was no limitation of motion (5260, 5261) to support a minimum rating for either knee, the panel agreed there was sufficient evidence of painful motion with functional loss IAW §4.59, §4.40 and §4.45 to support a 10% rating for each knee, as recorded by the primary care examination.  There was no history or evidence of dislocated meniscus or loose body causing frequent locking with recurrent effusions (5258), history of surgery to remove a meniscus (5259), and no fracture, nonunion or malunion of the femur, tibia or fibula which impaired the knee (5255, 5262), to support a 10% rating or higher under those codes for either knee.  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 knee 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 20170220, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Record

AR20190007812, 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