RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2017-03035
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20081224

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was a Reserve E4, Infantryman, medically separated for “bilateral knee patellofemoral syndrome,” rated 10% for each knee, 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 - 20081006	VARD - 20091028	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Right Knee Patellofemoral Syndrome	5099-5003	10%	Patellar Syndrome with Tendinitis, Right Knee	5299-5260	10%	20090602	
Left Knee Patellofemoral Syndrome	5099-5003	10%	Patellar Syndrome with Tendinitis, Right Knee	5299-5260	10%		
COMBINED RATING:  20%	COMBINED RATING OF ALL VA CONDITIONS:  60% 	

ANALYSIS SUMMARY:  

Bilateral Knee Patellofemoral Syndrome.  According to the service treatment record and MEB narrative summary (NARSUM), the CI’s bilateral knee condition began in June 2005 after running on uneven ground and falling on his knees during a deployment.  Despite 3 years of conservative therapy, nonsteroidal anti-inflammatory drugs, and physical therapy, his bilateral knee pain worsened.  Orthopedics determined his condition was not surgically compatible.   

The 9 September 2008 MEB NARSUM examination, 4 months prior to separation, noted CI complaints of constant bilateral knee pain worsened by squatting, kneeling, and standing from a seated position.  The right knee physical examination (PE) revealed crepitus and tenderness with range of motion (ROM) showing flexion to 110 degrees (normal 140), and normal extension to 0 degrees.  The left knee PE noted identical findings as the right, but ROM measurements showed flexion to 120 degrees and normal extension.  Reflexes and strength were normal to both lower extremities.  Left knee radiographic imaging was normal whereas the right knee had a small effusion and a small focus of partial thickness cartilage loss in the kneecap.  

At the 2 June 2009 VA Compensation and Pension (C&P) evaluation, 5 months after separation, the CI reported bilateral knee pain which stemmed from carrying heavy ruck sacks and patrolling on uneven rocky terrain.  The PE revealed a normal gait without muscle atrophy, effusion, or joint laxity; peripheral strength and sensation were intact.  Bilateral knee ROM measurements showed flexion to 130 degrees and normal extension.  The VA examiner noted radiographic evidence identical to the MEB NARSUM findings.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the left and right knee conditions 10% each, analogously coded to 5003 (arthritis, degenerative), citing limitation of motion with consideration given to VASRD para 4.59 (painful motion), VASRD 4.10 (functional impairment) and 4.40 (functional loss).  The VA likewise rated each knee at 10%, analogously coded to 5260 (leg, limitation of flexion) citing evidence of loss of range of motion with pain.  Panel members considered that the objective findings and associated disability for each knee were identical, and agreed with the PEB and the VA that the respective ratings should therefore be the same.  The panel concluded that there was sufficient evidence of painful motion and functional loss to support a 10% rating for each knee IAW §4.59 and §4.40.  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 patellofemoral syndrome condition.    

BOARD FINDINGS:  In the matter of the bilateral knee patellofemoral syndrome 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 20170418, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Record 

AR20180006196, 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