RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXX	CASE:  PD-2018-00323
BRANCH OF SERVICE:  Air Force 	SEPARATION DATE:  20071022

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E4, Munitions Systems Journeyman, medically separated for “bilateral patellofemoral syndrome” with a disability rating of 10%.   

CI CONTENTION:  “I was not whole person and only applied to my knees and not other conditions which I was told didn’t matter because of my knees.”  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 – 200709078	VARD – 20080313 & 20080417	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Bilateral Patellofemoral Syndrome 	5099-5003	10%	Chondromalacia Patella Right Knee	5003	10%	20071102	
			Degenerative Joint Disease Left Knee	5003	0%	20080327	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  30%	

ANALYSIS SUMMARY:  

Bilateral Patellofemoral Syndrome.  According to the service treatment record (STR) and MEB narrative summary (NARSUM), the CI underwent right knee arthroscopic surgery in May 2007.  Postoperatively, he reported decreased discomfort and near complete range of motion (ROM).  The 6 July 2007 MEB NARSUM examination, 4 months prior to separation, noted complaints of persistent knee pain.  Physical examination showed a normal gait without edema or effusion.  ROM testing of the knees revealed pain with flexion greater than 70 degrees.  There was no instability, but the patellar tap (fluid in the knee) and patellar grind tests were positive.  According to the commander’s statement, the CI was unable to lift more than 10 pounds, stand, march, stoop or crouch due to profile restrictions.  

At the 2 November 2007 VA Compensation and Pension (C&P) examination, less than 1 month after separation, the CI reported daily 5/10 bilateral knee pain with swelling of the right knee every 3-4 days.  Physical examination showed no redness, swelling, effusion, tenderness, instability or meniscal pathology in either knee.  Right knee ROM testing showed flexion of 130 degrees (normal 140) and extension of 0 degrees (normal).  There were no ROM measurements for the left knee.  X-rays of the right and left knees were negative.  During the 27 March 2008 C&P examination specifically for the left knee, 5 months after separation, the CI reported constant 3/10 left knee pain that increased with standing and walking.  Physical examination showed no objective evidence of painful motion, edema, effusion, instability, weakness, tenderness, redness, heat, abnormal movement or guarding, and gait was normal.  Left knee ROM testing showed flexion of 140 degrees and extension of 0 degrees.  Repetitive movements of the left knee increased pain, but did not change ROM.   X-rays of the left knee were negative.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB bundled the left and right knee conditions and applied a single 10% rating, coded 5003 (arthritis, degenerative).  The VA rated the right knee 10%, coded 5003, based on the C&P examination, citing painful or limited motion of a major joint.  A non-compensable rating was assigned for the left knee because there was no objective evidence of painful or limited motion.    

As noted in the commander’s statement, the CI was unable to perform the majority of his duties due to profile restrictions.  However, the commander’s statement and other STR evidence did not provide any information which would permit the panel to discriminate the performance limitations attributable to either knee over the other.  Since undue speculation would be required to conclude that impairment from either knee would not have unacceptably interfered with the performance of military duties, members agreed that each knee was reasonably justified as separately unfitting.  There was no limitation of motion which supported a rating under the diagnostic codes for limitation of flexion or extension (5260, 5261) for either knee. However, there was evidence of painful motion with functional loss supporting a 10% rating (based on §§4.59, 4.40 and 4.45) for each knee based on the NARSUM examination.  Panel members considered other knee and analogous codes, but all were less applicable or not advantageous to rating.  After due deliberation, and considering all the evidence, the panel recommends a disability rating of 10% for the right knee condition and 10% for the left knee condition, both coded 5099-5003.

BOARD FINDINGS:  In the matter of the left and right knee conditions, the panel recommends that each joint be separately adjudicated as follows: an unfitting right knee coded 5099-5003 and rated 10%, and an unfitting left knee, 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	
Right Patellofemoral Syndrome 	5099-5003	10%	
Left Patellofemoral Syndrome 	5099-5003	10%	
COMBINED	20%	

T
SAF/MRB
3351 Celmers Lane
JBA NAF Washington, MD 20762-6435

Dear XXXXXXXXXXXX

		Reference your application submitted under the provisions of DoDI 6040.44 (Section 1554, 10 USC), PDBR Case Number PD-2018-00323.

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.