RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2017-04761
BRANCH OF SERVICE:  Army  	SEPARATION DATE:  20060609

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

CI CONTENTION:  No specific contention was 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 - 20060516	VARD - 20070420	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Bilateral Patellar Tendonitis	5024	0%	Patellar Tendinitis Left Knee	5014	0%	STR	
			Patellar Tendinitis Right Knee	5014	0%	STR	
COMBINED RATING:  0%	COMBINED RATING OF ALL VA CONDITIONS:  0%	

ANALYSIS SUMMARY:  

Bilateral Patellar Tendonitis.  The PEB combined the right and left knee conditions under a single 0% disability rating, coded 5024 (tenosynovitis).  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’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 adjudicated by the PEB.  In this case, both knees were considered to fail retention standards.  They were implicated by the NARSUM and the commander’s statement, and both were profiled.  Panel members agreed the evidence reasonably justified that the functional limitations of the left and right knee conditions contributed to the CI’s inability to perform military duties, and accordingly separate disability ratings are recommended.

According to the service treatment record (STR) and MEB narrative summary (NARSUM), the CI’s bilateral patellar tendonitis began while deployed in 2004 without specific injury.  There were no radiographic studies found in the STR and surgery was not indicated.  A physical therapy (PT) examination on 23 Jan 2006, 5 months prior to separation, measured range of motion (ROM) for the right knee as flexion of 105 degrees (normal 140) and extension of -10 degrees (normal 0) with painful motion; and for the left knee as flexion of 95 degrees and extension of -10 degrees with painful motion.   The 21 April 2006 MEB NARSUM examination, 2 months prior to separation, noted complaints of constant pain worsened by climbing stairs and the inability to stand for longer than an hour.  Physical examination did not address the knees.  The examiner referred to the 23 January 2006 PT examination and measurements.   

At the 31 March 2007 VA Compensation and Pension (C&P) examination, 11 months after separation, the CI reported intermittent knee pain with certain types of activities.  Physical examination of both knees revealed mild discomfort during patellar compression testing; however, there was full extension and flexion to 125 degrees bilaterally without pain.  Repetitive motion did not result in changes in ROM.  Of note, this examination was conducted after the VA Rating Decision of 20 April 2007.

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the bilateral knee condition 0%, coded 5024, citing no compensable limitation of motion.  The VA rated the left and right knees 0% each, coded 5014 (osteomalacia), based on the STR, citing no current medical evidence to show compensable disability findings.  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).  No additional functional limitation was evidenced by the examinations.  However, there was documentation supporting a 10% rating for each knee due to painful limitation of motion IAW VASRD 4.59, 4.40 and 4.45, as recorded on the MEB NARSUM and noted in the PT examination, most proximate to separation.  After due deliberation, and considering all the evidence, the panel majority recommends a disability rating of 10% each for the right and left knee conditions, coded 5261 (Leg, limitation of extension of).

BOARD FINDINGS:  In the matter of the bilateral knee condition, the panel majority recommends that each joint be separately adjudicated as follows: an unfitting right knee condition coded 5261 and rated 10%, and an unfitting left knee condition coded 5261 and rated 10%, both IAW VASRD §4.71a.  The single voter for dissent recommends no change to the rating previously assigned, but does not elect to submit a minority opinion.  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	
Right Patellar Tendonitis	5261	10%	
Left  Patellar Tendonitis	5261	10%	
COMBINED	20%	

The following documentary evidence was considered:

[AR NUMBER], 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.

Enclosure