RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXX	CASE:  PD-2017-03283
BRANCH OF SERVICE:  Air Force 	SEPARATION DATE:  20060612

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E4, Information Management Journeyman, medically separated for “left knee patellofemoral pain syndrome” with a disability rating of 10%.   

CI CONTENTION:  In addition to her unfitting left knee pain and not unfitting migraines, the CI requested review of 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 - 20060421	VARD - 20070425	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Left Knee Patellofemoral Pain Syndrome	5099-5003	10%	Left Knee Disability	5257-5010	10%	20060222	
Migraine Headaches	Category II	Migraine Headaches	8100	0%		
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  30%	

ANALYSIS SUMMARY:  

Left Knee Patellofemoral Pain Syndrome (PFPS).  According to the service treatment record (STR) and MEB narrative summary (NARSUM), the CI underwent surgery on her left knee in July 2004 to remove a fold in the lining of the knee (plica removal) and release tendons to allow the kneecap to track properly (retinacular release).  Radiographic study of the knee in August 2005 showed no evidence of kneecap subluxation (partial dislocation, or instability).  During the 12 December 2005 orthopedic examination, 6 months prior to separation, the CI reported complaints of left knee pain and giving way, swelling, and locking of the knee, which prevented running or extended walking.  Physical examination showed full range of motion (ROM) as normal 0-140 degrees with crepitus (a popping or grinding noise or sensation on movement).  The knee showed mild tenderness, and testing for ligamentous instability and meniscal damage was negative.  There was irregular tracking of the kneecap.  Strength of the quadriceps muscles was rated 4+/5, with the remaining neurologic examination normal.  Left knee X-rays in February 2006 showed mild degenerative changes. 

At the 22 February 2006 VA Compensation and Pension (C&P) examination, 4 months before separation, the CI reported continued left knee pain and weakness that prevented running, taking long walks, and climbing stairs.  Physical examination showed the CI’s gait was “slightly altered by her inability to fully extend her left knee while walking,” with no use of a brace or assistive device.  The left knee had no swelling, discoloration, or fluid buildup, but was tender.  Knee ROM was recorded as 0-130 degrees, with painful motion and severe crepitus noted, and the CI guarded her left knee throughout the examination.  Knee pain increased with repetitive motion weakened with movement, and incoordination was noted, but ROM did not decrease.  There was no evidence of lateral instability, and testing for ligamentous instability and meniscal damage were negative.  According to the examiner, the kneecap did not move smoothly, and as the CI flexed and extended her leg “something in her knee” caused it to catch.

The 8 March 2006 MEB NARSUM examination, 3 months prior to separation, noted complaints of continued left knee symptoms.  Physical examination showed mild swelling with no fluid buildup in the knee joint and no discoloration.  The knee was tender, and ROM was recorded as 0-130 degrees, with significant guarding on extension.  There was patellofemoral pain with patellar grind and a positive patellar apprehension test (possible lateral kneecap instability), with testing for ligamentous instability (Lachman, drawer sign, and varus/valgus) all negative.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the left knee at 10%, coded 5099-5003 (analogous to degenerative arthritis).  The VA rated the left knee at 0%, but used the 5257-5010 dual code (knee, other impairment of recurrent subluxation or lateral instability – arthritis due to trauma), based on the C&P examination.  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 (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 than a 10% rating supported under any applicable VASRD code.  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 condition.  

Contended PEB Condition:  Migraine Headaches.  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 left knee patellofemoral pain syndrome and IAW VASRD §4.71a, the panel recommends no change in the PEB adjudication.  In the matter of the contended migraine headaches 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.  Therefore, the panel recommends no modification or re-characterization of the CI’s disability and separation determination.  

The following documentary evidence was considered:

SAF/MRB

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Dear XXXXXXXXXX:

		Reference your application submitted under the provisions of DoDI 6040.44 (Section 1554, 10 USC), PDBR Case Number PD-2017-03283.

After careful consideration of your application and treatment records, the Physical Disability Board of Review determined that the rating assigned at the time of final disposition of your disability evaluation system processing was appropriate.  Accordingly, the Board recommended no re-characterization or modification of your separation.

I have carefully reviewed the evidence of record and the recommendation of the Board.  I concur with that finding and their conclusion that re-characterization of your separation is not warranted.  Accordingly, I accept their recommendation that your application be denied.