RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW
NAME:  XXXXXXXXXXXXXXXXXXXX	CASE: PD‐2017‐06007
BRANCH OF SERVICE: ARMY	SEPARATION DATE: 20080205

SUMMARY OF CASE: Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E2, Canon Crewmember, medically separated for “patellofemoral pain syndrome (PFPS), both knees,” with a disability rating of 10%.

CI CONTENTION: “Please 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 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 ‐ 20090220	VARD ‐ 20080528	
Condition	Code	Rating	Condition	Code	Rating	Exam	
PFPS, Both Knees	5099‐5003	10%	PFPS, Right Knee	5099‐5014	10%	20080227	
			PFPS, Left Knee	5099‐5014	10%	20080227	
COMBINED RATING: 10%	COMBINED RATING OF ALL VA CONDITIONS: 30%	

ANALYSIS SUMMARY:

PFPS, Both Knees. According to the service treatment record and MEB narrative summary (NARSUM), the CI’s bilateral knee pain began in January 2007 without injury or trauma. Radiographic studies were normal. During the 29 November 2007 MEB examination (recorded on DD Forms 2807‐1 and 2808), 2 months prior to separation, the CI reported swollen and painful knees which gave out and were aggravated by navigating stairs or stretching. Physical examination showed a normal lower extremity examination. The 27 December 2007 MEB NARSUM examination, one month prior to separation, noted complaints of bilateral knee pain that increased with squatting, kneeling, use of stairs, and prolonged sitting. The CI denied locking, but indicated that due to a sensation of weakness his knees gave out when he stood and walked. Physical examination showed crepitus with tenderness on the anterior aspects and patellofemoral regions of both knees. Gait and knee range of motion (ROM) were normal. There was no joint line tenderness, swelling or edema noted in either knee. Provocative testing to elicit ligamentous instability or meniscal pathology was negative.

At the 27 February 2008 VA Compensation and Pension (C&P) examination, one month after separation, the CI reported right knee pain greater than left knee with flares to 8/10 precipitated

by climbing more than one flight of stairs, sitting for more than 30 minutes, walking for more than 2 miles or running. He also complained of daily stiffness and giving way, but denied locking or lack of endurance. Physical examination revealed a normal gait without effusion, ligamentously stable knee joints, and no meniscal pathology. Knee ROM testing showed right and left knee hyperextension of 10 degrees (normal 0) and flexion of 130 degrees (normal 140). Painful motion on the right started at 90 degrees of flexion and on the left started at 110 degrees. There was no additional loss of motion after repetition.

The panel directed attention to its rating recommendation based on the above evidence. The PEB rated the bilateral knee condition 10%, analogously coded 5099‐5003 (degenerative arthritis), citing “minor functional loss caused by pain from repeated use or flare‐ups.” The VA rated each knee condition 10%, analogously coded 5099‐5014 (osteomalacia), based on the C&P examination, citing “functional loss due to pain which affects the performance of normal working movements of the knees with normal excursion, strength, speed, coordination and endurance.” The panel first considered if the right and left knee conditions, having been de‐coupled from the combined PEB adjudication, remained separately unfitting as established above. Both knees were implicated in the commander’s letter and both failed retention standards by the MEB. Therefore, 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 his military duties, and accordingly separate disability ratings are recommended.

The panel considered multiple VASRD knee and analogous codes, but these were less applicable and/or not advantageous for rating. However, there was evidence of painful motion in each knee with functional loss supporting a 10% rating (based on §§4.59, 4.40 and 4.45) for each knee. In the matter of the bilateral knee condition, the panel recommends that each joint be separately adjudicated as unfitting right and unfitting left knee conditions each coded 5099‐5003 and each rated 10%, both IAW VASRD §4.71a.

BOARD FINDINGS: In the matter of the bilateral patellofemoral pain syndrome, the panel recommends a disability rating of 10%, coded 5099‐5003 for the right knee and 10% for the left knee IAW VASRD §4.71. 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 Pain Syndrome, Right Knee	5099‐5003	10%	
Patellofemoral Pain Syndrome, Left Knee	5099‐5003	10%	
	COMBINED	20%	

2	PD‐2017‐06007

DEPARTMENT OF THE ARMY
ARMY REVIEW BOARDS AGENCY 251 18TH STREET SOUTH, SUITE 385
ARLINGTON, VA 22202-3531

100AR20200003994, 

Dear XXXXXXXXXXXXXX:

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.

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