RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME: XXXXXXXXXXXXXXXXXX	CASE:  PD-2017-04079
BRANCH OF SERVICE:  Air Force 	SEPARATION DATE:  20050614

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E3, Tactical Aircraft Maintenance Helper, medically separated for “[right] patellofemoral pain syndrome” with a disability rating of 10%.  

CI CONTENTION:  “Review all conditions.”  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 - 20050420	VARD - 200550823	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Right Patellofemoral Pain Syndrome	5003-5099	10%	Right Knee Extension	5261	20%	20050620	
			Right Knee Flexion	5260	10%	20050620	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  60%	

ANALYSIS SUMMARY:  

Right Patellofemoral Pain Syndrome.  According to the service treatment record (STR) and MEB narrative summary (NARSUM), the CI underwent exploratory arthroscopy with no significant findings on 20 July 2004.  The 9 December 2004 physical therapy examination showed full active flexion and extension, but there was tenderness of the patellar tendon and inferior patella.  Strength was 5/5 and he could do a full squat, but could only do 90% of a one-legged squat.  A post-surgical MRI, dated 16 February 2005, showed chondromalacia, but no convincing evidence of a meniscal tear.  At the 18 February 2005 orthopedic examination, 4 months prior to separation, the CI complained of continuing right knee pain.  On physical examination, the CI walked with a limp and was noted to have diffuse tenderness, but he had full range of motion (ROM) and there was no effusion.  The 7 March 2005 MEB NARSUM examination, 3 months prior to separation, noted complaints of anterior right knee pain exacerbated with navigating stairs or sitting.  Physical examination showed the CI walked with a limp, used a cane and had a positive patellar grind test.  

At the 20 June 2005 VA Compensation and Pension (C&P) examination, one week after separation, the CI reported daily 5/10 right knee pain with occasional swelling, popping and give-way.  Physical examination showed an antalgic gait to the right and the examiner noted the CI carried a cane in the left hand.  There was tenderness, but no effusion.  The ROM evaluation noted extension lacked 15 degrees (normal 0) and flexion was 100 degrees (normal 140).  There was no fatigability or crepitation, but the CI complained of pain at the terminal ends of motion, however there was no change after repetition.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the right knee condition 10%, analogously coded 5003-5099 (degenerative arthritis).  The VA dual rated the right knee condition 20%, coded 5261 (limitation of extension) and 10%, coded 5260 (limitation of flexion), based on the C&P examination, citing extension limited to 15 degrees and flexion limited to 100 degrees with pain.

The panel first considered the conflicting examinations and agreed the VA examination was inconsistent with STR entries proximate to separation, which showed full active ROM.  Therefore, the panel awarded more probative value to the STR entries.  There was no limitation of motion which supported a rating under the diagnostic codes for limitation of flexion or extension (5260, 5261).  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 higher than the 10% adjudicated by the PEB under any applicable code.  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 right knee condition.  

BOARD FINDINGS:  In the matter of the right 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 20170404, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Record

SAF/MRB
1500 West Perimeter Road, Suite 3700
Joint Base Andrews, MD 20762

XXXXXXXXXXXXXXXXXX

Dear XXXXXXXXXXXXXXXXXX

		Reference your application submitted under the provisions of DoDI 6040.44 (Section 1554, 10 USC), PDBR Case Number PD-2017-04079.

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.

						Sincerely,

		

Attachment:
Record of Proceedings