RECORD OF PROCEEDINGS PHYSICAL DISABILITY BOARD OF REVIEW
NAME:  XXXXXXXXXXXXXXXXXX	CASE: PD-2017-02627
BRANCH OF SERVICE: ARMY	SEPARATION DATE: 20071130

SUMMARY OF CASE: Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E4, Lithographer, medically separated for “patellofemoral syndrome, bilateral” with a disability rating of 0%.

CI CONTENTION: “Issues that were factored into my rating from the VA were not considered by the Army at time of separation.”  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 - 20070928	VARD - 20080520	
Condition	Code	Rating	Condition	Code	Rating	Exam	

Patellofemoral Syndrome, Bilateral	
5099-5003	
0%	Patellofemoral Pain Syndrome, Left Knee	5257	0%	20080130	
			Patellofemoral Pain Syndrome, Right Knee	5257	0%	20080130	
Anxiety Disorder	Not Unfitting	Anxiety	9400	30%	20080215	
COMBINED RATING: 0%	COMBINED RATING OF ALL VA CONDITIONS: 50%	
	
ANALYSIS SUMMARY:

Bilateral Patellofemoral Syndrome. The PEB combined the knee conditions under a single disability rating, analogously coded 5099-5003 (arthritis, degenerative) and rated 0%. This approach by the PEB not uncommonly reflected its judgment that the constellation of conditions was unfitting, and there was no need for separate fitness adjudications. The panel noted that “bundling,” the combining of two or more major joints, may be permissible under the VASRD

5003 rating requirements, and that this approach does not compromise the VASRD §4.7 directive to choose the higher of two valid ratings. The panel’s initial charge in this case was therefore directed at determining if combining conditions under a single rating was justified in lieu of separate ratings. When considering a separate rating for each condition, the panel considers each bundled condition to be reasonably justified as separately unfitting unless a preponderance of evidence indicates the condition would not cause the member to be referred into the DES or be found unfit because of physical disability. When the panel recommends separate fitness recommendations in this circumstance, its recommendations may not produce a lower combined rating than that of the PEB. The evidence for the left and right knee conditions are presented together, with attendant recommendations regarding separate unfitness, and separate rating if indicated.

According to the service treatment record (STR) and MEB narrative summary (NARSUM), the CI’s bilateral knee condition began in July 2005 after running. During the 16 April 2007 MEB examination (recorded on DD Forms 2807-1 and 2808), 7 months prior to separation, physical examination showed pain with range of motion (ROM) and no laxity or effusion. The 18 June 2007 MEB NARSUM examination, 5 months before separation, noted CI complaints of persistent bilateral knee pain. Physical examination of both knees showed no clubbing, cyanosis or edema. Grinding of the right knee was greater than the left knee, but there was no laxity or effusion of either knee. Bilateral ROM measurements revealed flexion to 135 degrees (normal 140) and extension to 1 degrees (normal 0), after multiple repetitions and with pain, but ROM was not limited by pain or mechanical condition.

At the 30 January 2008 VA Compensation and Pension (C&P) examination, 2 months after separation, the CI reported constant bilateral superior patellar area pain and pain deep in the knee joint area. Physical examination revealed a normal gait and station. Both knees were stable and showed no effusion, redness, swelling or tenderness. Right knee flexion was to 146 degrees and extension to 0 degrees, and left knee flexion to 145 degrees and extension to 0 degrees. Both knee ROMs were without observed manifestation of pain and there were no additional limitation after repetitive motion. There was no abnormal crepitus in the patella area with passive or active ROM of the right knee, and X-rays of both knees were normal.

The panel directed attention to its rating recommendation based on the above evidence. As noted above, the PEB rated the bilateral knee condition 0%, analogously coded 5099-5003, citing painful ROM, no mechanical loss of motion, and AR 635-40, para B-15. The VA rated the left and right knee conditions 0% each, coded 5257 (knee, other impairment of), based on the C&P examination, citing chronic disability without limited or painful motion bilaterally. The panel first considered whether either of the knee conditions, having been de-coupled from the combined PEB adjudication, remained separately unfitting as established above. The profile, commander’s statement, NARSUM, MEB and STR evidence did not provide any information which would permit the panel to discriminate the performance limitations attributable to either knee over the other. Physical and X-ray findings were essentially identical. Since undue speculation would be required to conclude that impairment from either knee would not have unacceptably interfered with military specialty performance, members agreed that each knee was reasonably justified as separately unfitting.

Panel members agreed that there was no limitation of flexion or extension that supported a rating under code 5260 or 5261. Also, there was no history of dislocated meniscus or loose body causing frequent locking with recurrent effusions (5258); or fracture, non-union, or malunion of the femur or tibia to support consideration under the respective codes for knee impairment related to long bone conditions (5255, 5262). However, there was evidence of painful motion of each knee with functional loss to support a 10% rating (based on §4.59, §4.40 and §4.45). After due deliberation, considering all the evidence, the panel recommends separately unfit determinations, with disability ratings of 10% each, for the left and right knee conditions.

Contended PEB Condition: Anxiety Disorder. The panel’s main charge is to assess the fairness of the PEB determination that the contended condition was not unfitting. The contended condition was not profiled or implicated in the commander’s statement, and did not fail retention standards. There was no performance-based evidence from the record that the condition 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 the contended condition, so no additional disability rating is recommended.

BOARD FINDINGS: In the matter of the bilateral knee condition, the panel recommends that each joint be separately adjudicated as follows: an unfitting left knee condition coded 5099-5003 and rated 10%, and an unfitting right knee condition, coded 5099-5003 and rated 10%, both IAW VASRD §4.71a. In the matter of the contended anxiety disorder condition, the panel recommends no change from the PEB determination as not unfitting. There are no other conditions within the panel’s scope of review for consideration.

The panel recommends the CI’s prior determination be modified as follows, effective the date of medical separation:

CONDITION	VASRD CODE	PERMANENT RATING	
Patellofemoral Syndrome, Left Knee	5099-5003	10%	
Patellofemoral Syndrome, Right Knee	5099-5003	10%	
	COMBINED	20%	

The following documentary evidence was considered:

Exhibit A. DD Form 294, dated 20170317, w/atchs Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Record

AR2019007581, XXXXXXXXXXXXXXXXXX

XXXXXXXXXXXXXXXXXX

Dear XXXXXXXXXXXXXXXXXX

The Department of Defense Physical Disability Board of Review (DoD PDBR) reviewed your application and found that your disability rating should be modified but not to the degree that would justify changing your separation for disability with severance pay to a permanent retirement with disability.  I have reviewed the Board’s recommendation and record of proceedings (copy enclosed) and I accept its recommendation.  This will not result in any change to your separation document or the amount of severance pay.  A copy of this decision will be filed with your Physical Evaluation Board records.  I regret that the facts of the case did not provide you with the outcome you may have desired.
  
	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. 

	A copy of this decision has also been provided to the Department of Veterans Affairs.