RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME: XXXXXXXXXXXXXXX	CASE:  PD-2014-00054
BRANCH OF SERVICE: Army	BOARD DATE:  20140829
SEPARATION DATE:  20071005

SUMMARY OF CASE: Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty SSG/E-6 (56M/Chaplain’s Assistant) medically separated for a right knee condition.  The knee could not be adequately rehabilitated to meet the physical requirements of his Military Occupational Specialty.  The CI was permitted to take the alternate Army physical fitness test.  He was issued a permanent L3 profile and referred for a Medical Evaluation Board (MEB).  The knee condition, characterized as “chondromalacia patella,” was the only condition forwarded to the Physical Evaluation Board (PEB) IAW AR 40-501.  The PEB adjudicated “patellofemoral syndrome of the right knee” as unfitting, rated at 0%, with likely application of the Veterans Affairs Schedule for Rating Disabilities (VASRD).  The CI made no appeals and was medically separated.

CI CONTENTION:  The CI writes: “Separated for patellofemoral pain syndrome of the right knee only dx original PEB.  I believe there was a lack of review of medical records.  As VA Physical shows I should have been evaluated for items listed in block 12”. Block 12 of the DD Form 294 included the following conditions: right knee patellar osteophyte; left knee patellar tendinitis & patellofemoral syndrome; tibialis externum of right foot; tibialis externum of left foot and gastroesophageal reflux disease.

SCOPE OF REVIEW: The Board’s scope of review is defined in DoDI 6040.44, Enclosure 3, paragraph 5.e.(2).  It is limited to those conditions determined by the PEB to be unfitting for continued military service and those conditions identified but not determined to be unfitting by the PEB when specifically requested by the CI.  The rating for the unfitting right knee is addressed below; no additional conditions, including the CI’s contended conditions per above, are within the DoDI 6040.44 defined purview of the Board.  Any conditions or contention not requested in this application, or otherwise outside the Board’s defined scope of review, remain eligible for future consideration by the Board for Correction of Military Records.

RATING COMPARISON:

Service IPEB – Dated 20070717	VA - (3 Mos. Post-Separation)	
Condition	Code	Rating	Condition	Code	Rating	Exam	
PFPS, R Knee	5099-5003	0%	R Knee Patellar Osteophyte	Not available
	10%	20080111	
Other x 0 (Not in Scope)	Other x 4	20080111	
Combined:  0%	Combined: 50%	
Derived from VA Rating Decision (VARD) dated 20080219 (most proximate to date of separation)

ANALYSIS SUMMARY:

Patellofemoral Pain Syndrome (PFPS), R Knee.  The CI had a history of right knee pain, dating back to at least 1999, which was initially managed conservatively.  However, his pain progressed and he no longer met full duty requirements by 2005.  A magnetic resonance imaging on 28 July 2006 showed a thickened lining of the joint.  Diagnostic arthroscopy on 12 September 2006 showed degeneration of the cartilage of the knee cap and it was debrided.  The ligaments and menisci were noted to be intact.  Despite rehabilitation and duty restrictions, he did not improve sufficiently to return to full activities and was issued a L3 profile and referred for MEB.  At the MEB examination on 2 December 2006, approximately 3 months after the arthroscopic surgery, the CI reported ongoing use of a knee brace.  

The MEB physical examination was a month later.  The examiner noted tenderness and a reduced range-of-motion (ROM), but no swelling or effusion.  The narrative summary was dated 25 June 2007, 4 months prior to separation and 9 months after the surgery.  The CI reported continued pain.  On examination, he had a normal gait and the knee was without warmth or effusion.  He lacked five degrees of full flexion.  There was no instability and signs of meniscal irritation were absent.  His response to both surgical and non-surgical treatment was not sufficient for him to return to full duty.  At the VA Compensation and Pension examination performed 3 months after separation, the CI reported left and right knee pain and the use of a brace.  He had a sedentary job and managed (to do) well.  On examination, the knee was stable without signs of meniscal irritation.  The gait was normal.  The ROM was painful and flexion again reduced by five degrees.  On X-ray, a small bony growth was noted (an osteophyte, a sign of degenerative arthritis), but was otherwise normal.  The goniometric ROM evaluations in evidence which the Board weighed in arriving at its rating recommendation, with documentation of additional ratable criteria, are summarized in the chart below.

Right Knee ROM
(Degrees)	PT ~6 Mo. Pre-Sep	MEB ~4 Mo. Pre-Sep	VA C&P ~3 Mo. Post-Sep	
Flexion (140 Normal)	135	135	135	
Extension (0 Normal)	-5	---	0	
Comment		Nml gait	Painful motion; nml gait	
§4.71a Rating	10%	10%	10%	

The Board directed attention to its rating recommendation based on the above evidence.  The PEB rated the right knee at 0% while the VA rated the knee condition at 10%.  The PEB used the 5009-5003 code, analogous to degenerative joint disease, the correct analogous code for patellofemoral pain syndrome.  The Board considered the findings and coding options for the knee and found there to be painful motion, which allows for a pathway to rating of 10% (as adjudicated by the VA).  After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the Board concluded that there was sufficient cause to recommend a change in the PEB adjudication for the right knee condition.

BOARD FINDINGS:  IAW DoDI 6040.44, provisions of DoD or Military Department regulations or guidelines relied upon by the PEB will not be considered by the Board to the extent they were inconsistent with the VASRD in effect at the time of the adjudication.  The Board did not surmise from the record or PEB ruling in this case that any prerogatives outside the VASRD were exercised.  In the matter of the right knee condition, the Board unanimously recommends a disability rating of 10%, coded 5009-5003 IAW VASRD §4.71a.  There were no other conditions within the Board’s scope of review for consideration.

RECOMMENDATION: The Board recommends that the CI’s prior determination be modified as follows, effective as of the date of his prior medical separation:

UNFITTING CONDITION	VASRD CODE	RATING	
Patello-femoral Pain Syndrome of the Right Knee	5009-5003	10%	
COMBINED	10%	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20131219, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans’ Affairs Treatment Record

				
XXXXXXXXXXXXXXX
President
Physical Disability Board of Review

SAMR-RB									

MEMORANDUM FOR Commander, US Army Physical Disability Agency 
(AHRC-DO), 2900 Crystal Drive, Suite 300, Arlington, VA  22202-3557

SUBJECT:  Department of Defense Physical Disability Board of Review Recommendation 
for XXXXXXXXXXXXXXX, AR20150007063 (PD201400054)

1.  I have reviewed the enclosed Department of Defense Physical Disability Board of Review (DoD PDBR) recommendation and record of proceedings pertaining to the subject individual.  Under the authority of Title 10, United States Code, section 1554a,   I accept the Board’s recommendation to modify the individual’s disability rating to 10% without recharacterization of the individual’s separation.  This decision is final.  

2.  I direct that all the Department of the Army records of the individual concerned be corrected accordingly no later than 120 days from the date of this memorandum.   

3.  I request that a copy of the corrections and any related correspondence be provided to the individual concerned, counsel (if any), any Members of Congress who have shown interest, and to the Army Review Boards Agency with a copy of this memorandum without enclosures.

BY ORDER OF THE SECRETARY OF THE ARMY:

Encl		     XXXXXXXXXXXXXXX
			     Deputy Assistant Secretary of the Army
			         (Review Boards)

CF: 
(  ) DoD PDBR
(  ) DVA