RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXXXXXX	CASE:  PD-2017-05096
BRANCH OF SERVICE:  Air Force 	SEPARATION DATE:  20061106

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 “patellofemoral dysfunction” with a disability rating of 10%.   

CI CONTENTION:  In addition to review of her unfitting knee condition, the CI requested review of additional conditions not identified by the Medical Evaluation Board (MEB) and/or 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 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 - 20060905	VARD - 20061205	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Patellofemoral Dysfunction 	5099-5003	10%	Lt Knee Patellofemoral  Syndrome 	5299-5260	10%	20060922	
			Rt Knee Patellofemoral Syndrome 	5299-5260	10%	20060922	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  50%	

ANALYSIS SUMMARY:  

Patellofemoral Dysfunction.  According to the service treatment record (STR) and MEB narrative summary (NARSUM), the CI’s patellofemoral dysfunction (bilateral) condition began in 2003 during basic training with a gradual onset but no specific injury or trauma.  She had limited relief of her knee pain, the right greater than the left, with physical therapy, nonsteroidal anti-inflammatory drugs, activity modification, and physical profiling.  X-rays performed in March 2006 and May 2006 showed normal right and left knees respectively.   

The 24 May 2006 MEB NARSUM examination, 5 months prior to separation, noted complaints of knee pain with running and climbing stairs.  Physical examination showed neither knee with an effusion.  Range of motion (ROM) measurements were 0-130 degrees (normal 0-140) without pain.  McMurray’s test (to determine a meniscal tear), and Lachman’s, anterior/posterior drawer, and varus/valgus stress tests (to determine instability and laxity) were negative.  There was minimal patellar crepitus (grinding) with flexion.  
At the 22 September 2006 VA Compensation and Pension (C&P) examination, one month before separation, the CI reported pain that was squeezing, aching, sharp, and cramping in nature. Physical examination showed no signs of edema, effusion, weakness, tenderness, redness, heat, or abnormal or guarding movement for either knee.  Both knees revealed minimal crepitus.  ROM was 135 degrees flexion and 0 degrees extension (normal 0) with pain.  The joint function was additionally limited 5 degrees by pain, fatigue, weakness, and lack of endurance after repetition, but was not additionally limited by incoordination.  There was no instability, laxity, or evidence of a meniscal tear in either knee.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the patellofemoral dysfunction condition 10%, analogously coded 5099-5003 (degenerative arthritis), citing DoD and VASRD guidelines.  The VA rated the each knee separately, with the left and right knee condition 10% each, analogously coded 5299-5260 (limitation of flexion of leg), based on the C&P examination, citing pain in both knees, negative X-rays, and 0-135 degrees ROM in each knee.   

In this case, the bilateral knee condition was forwarded to the PEB, and both knees were implicated by the NARSUM and both knees were profiled.  The commander’s letter alluded to the right and left by using the term “knees.”  Other STR evidence did not provide any information which would permit the panel to determine performance limitations attributable to one knee over the other.  Since undue speculation would be required to conclude that either left and/or right knee impairment would not have unacceptably interfered with the performance of military duties, members agreed each knee was reasonably justified as separately unfitting.  

Panel members considered the objective findings and associated disability for each knee were for all intents and purposes identical, and agreed with the VA that the respective ratings should be the same (for painful or limited motion of a major joint).  The panel concluded that there was sufficient evidence of painful motion and functional loss to support a 10% rating for each knee IAW VASRD §§4.59 and 4.40.  In considering a higher rating, there was no limitation of motion which attained a minimum rating under the diagnostic codes for limitation of flexion (5260) or extension (5261).  The panel considered other VASRD knee and analogous codes, but all were less applicable and/or not advantageous for rating.  Therefore, there was 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 recommends a disability rating of 10% for the right knee condition and 10% for the left knee condition, each coded 5099-5003.  

BOARD FINDINGS:  In the matter of the patellofemoral dysfunction (bilateral) condition, the panel recommends each knee joint be separately adjudicated as follows: an unfitting right knee condition coded 5099-5003 and rated 10%, and an unfitting left knee condition, coded 5099-5003 and rated 10%, both IAW VASRD §4.71a.  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 Dysfunction, Left Knee	5099-5003	10%	
Patellofemoral Dysfunction, Right Knee	5099-5003	10%	
COMBINED	20%	

SAF/MRB

Dear XXXXXXXXXXX:

		Reference your application submitted under the provisions of DoDI 6040.44 (Section 1554, 10 USC), PDBR Case Number PD-2017-05096.

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 not in accordance with the guidelines of the Veterans Affairs Schedule for Rating Disabilities.  Accordingly, the Board recommended modification of your assigned disability rating without re-characterization of your separation with severance pay. 

I have carefully reviewed the evidence of record and the recommendation of the Board.  I concur with that finding, accept the recommendation and direct that your records be corrected as set forth in the attached copy of a Memorandum for the Chief of Staff, United States Air Force.  This will not result in any change to your separation documents or the amount of severance pay you are entitled to.  Disability severance pay is computed the same regardless of a rating of 0, 10 or 20 percent.