RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXX	CASE:  PD-2017-05137
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20090619

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 “patellofemoral syndrome, left knee” and “patellofemoral syndrome, right knee,” rated 10% each, with a combined disability rating of 20%.   

CI CONTENTION:  “I still to this day have to take morphine, valium and see a doctor regularly.” 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 - 20090518	VARD - 20090701	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Patellofemoral Syndrome, Left Knee	5099-5024	10%	Patellofemoral Syndrome, Left Knee	5099-5024	10%	20090506	
Patellofemoral Syndrome, Right Knee	5261	10%	Patellofemoral Syndrome, Right Knee	5261	10%	20090506	
COMBINED RATING:  20%	COMBINED RATING OF ALL VA CONDITIONS:  40%	

ANALYSIS SUMMARY:  

Left Knee Patellofemoral Syndrome.  According to the service treatment record (STR) and MEB evaluation, the CI’s left knee condition began in 2005 without specific injury. An MRI showed an anterior cruciate ligament (ACL) strain, and surgery was not indicated.  
At the 24 December 2008 VA Compensation and Pension (C&P) examination, 6 months before separation, the CI reported pain with walking.  Physical examination revealed that he favored his left leg with less weight.  There was pain on balottement (sign of swelling) of the patella, positive lateral collateral ligament laxity, and pain on flexion greater than 45 degrees.  Range of motion (ROM) measurements for extension and flexion were not recorded.  Coordination was normal and neurological findings intact.  The 5 February 2009 NARSUM evaluation, 4 months prior to separation, noted CI complaints of pain attributed to activities required of military duties with the Honor Guard.  The examiner cited the VA examination results.  At the 6 May 2009 VA C&P examination, 1 month before separation, physical examination showed a normal gait but crepitus and guarding of movement.  There was no instability, grinding, or patellar, meniscal, or tendon/bursae abnormalities.  Measured ROM showed flexion of 120 degrees (normal 140), with painful motion, but no degraded ROM after repetition. 

The panel directed attention to its rating recommendation based on the above evidence.  The PEB accepted the 10% rating, as determined by the VA, for the unfitting left knee condition, analogously coded as 5099-5024 (tenosynovitis).  (Note:  This case was adjudicated under the DES DOD/VA Pilot Program, where the VA performed the service examination (not the MEB) and proposed the ratings.)  The VA rated the left knee condition 10%, analogously coded as 5099-5024, based on the C&P examination, citing objective findings of pain after repetitive motion.  Members noted 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), history of surgery to remove a meniscus (5259), or 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).  Therefore, there was no VASRD §4.71a rating higher than the 10% assigned 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 adjudication for the left knee condition.  

Patellofemoral Syndrome, Right Knee: According to the STR and MEB evaluation, the CI’s right knee condition began in 2006 after favoring the left knee.  There were no radiographic studies of the right knee and no surgical indication.  

At the 24 December 2008 VA C&P examination, the CI reported pain with walking, and the examiner noted positive lateral collateral ligament laxity and normal neurological findings. Extension and flexion measurements were not recorded.  The NARSUM examiner recorded complaints of pain attributed to military duties, and cited the VA examination results.  At the 6 May 2009 VA C&P examination revealed a normal gait and crepitus but no instability, grinding, or patellar, meniscal, or tendon/bursae abnormalities.  Measured right knee ROM showed 124 degrees of flexion and extension limited by 10 degrees, with painful motion but no additional limitations after repetition.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB accepted the 10% rating, as determined by the VA, for the unfitting right knee condition, coded 5261 (leg, limitation of extension.  The VA rated the left knee condition 10%, based on the C&P examination, citing objective findings of pain after repetitive motion.  Panel members agreed that while the limited right knee extension supported a 10% rating under code 5261, there was no limitation of flexion that supported a rating under code 5260.  Additionally, there was no history or evidence of dislocated meniscus or loose body causing frequent locking with recurrent effusions (5258), history of surgery to remove a meniscus (5259), or 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.  Therefore, there was no VASRD §4.71a rating higher than the 10% assigned 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 adjudication for the right knee condition.  

BOARD FINDINGS:  In the matter of the left knee condition and IAW VASRD §4.71a, the panel recommends no change in the adjudication.  In the matter of the right knee condition and IAW VASRD §4.71a, the panel recommends no change in the adjudication.  There are no other conditions within the panel’s scope of review for consideration.  Therefore, the panel recommends no re-characterization of the CI’s disability and separation determination.  

AR20190004971, XXXXXXXXXX

Dear XXXXXXXXXX:

	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.