RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2014-00932
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20080525

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty, E4, Food Service Operations, medically separated for “right knee pain from patellofemoral pain syndrome,” with a disability rating of 0%.

CI CONTENTION:  The CI contended for both his right and left knees as well as skin cancer and a mental health condition.  The CI’s complete submission is at Exhibit A.  

SCOPE OF REVIEW:  The Board’s scope of review is defined in DoDI 6040.44.  It is limited 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 PEB, but determined to be not unfitting.  Any conditions outside the Board’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.  Furthermore, the Board’s authority is limited to assessing the fairness and accuracy of PEB rating determinations and recommending corrections, where appropriate.  The Board’s assessment of the PEB rating determinations is confined to review of medical records and all available evidence for application of the Veterans Affairs Schedule for Rating Disabilities (VASRD) standards to the unfitting medical condition at the time of separation.  The Board 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, operating under a different set of laws.  The Board gives consideration to VA evidence, particularly within 12 months of separation, but only to the extent that it reasonably reflects the severity of the disability at the time of separation.  

RATING COMPARISON:  

SERVICE PEB - 20080312	VARD - 20080730	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Right Knee Pain from Patellofemoral Syndrome	5099-5003	0%	Right Knee Patellofemoral Syndrome	5024-5260	10%	20080409	
COMBINED RATING:  0%	COMBINED RATING OF ALL VA CONDITIONS:  20%	

ANALYSIS SUMMARY:  

Right Knee Pain.   According to service treatment records (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s right knee pain (diagnosed as patellofemoral syndrome [PFS]) began during basic training in 2005 after running for physical training.  Diagnostic imaging performed in 2007 did not reveal any boney or soft tissue abnormalities about the right knee.  There was no surgical indication, and conservative treatment did not result in improvement sufficient to allow unrestricted duty.  The MEB forwarded “right knee PFS” for PEB adjudication.

At the MEB NARSUM examination on 4 January 2008, 5 months prior to separation, the CI reported 5 to 6 hours per day of aching pain in his right knee, with intensity of 5/10.  He denied locking or swelling but experienced knee stiffness with inactivity.  His pain worsened with lifting more than 20 pounds, running, jumping or standing more than 2 hours.  The pain improved with rest and medication.  Physical examination (PE) revealed the CI had a normal gait and was able to heel-and-toe walk.  He did not use any assistive devices to ambulate.  He had full active range of motion (ROM) of the right knee.  Tenderness and grinding were present.  No weakness, incoordination or lack of endurance were noted during ROM testing.  There was no edema, effusion, bruising, redness, warmth, abnormal movement, guarding, asymmetry or atrophy noted.  All tests for instability were negative and lower extremity strength, sensation and reflexes were normal.  At the VA Compensation and Pension (C&P) examination performed on 9 April 2008, 2 months before separation, the CI reported the inability to run.  His PE revealed a normal gait without the use of assistive devices.  He was unable to squat down due to his right knee condition.  There was no swelling or edema present.  His right knee ROM was measured as 120 degrees of flexion (pain initiated) and 0 degrees of extension.  Repetitive ROM testing demonstrated no additional loss of joint motion.  Right knee tenderness was present.  All tests for instability were negative.

The Board directed attention to its rating recommendation based on the above evidence.  The PEB assigned a 0% rating under an analogous 5099-5003 code (arthritis, degenerative) citing no evidence of painful motion, no ratable loss of motion and rating in accordance with VASRD §4.31 (use of a “no-percent” rating).  The PEB also referenced the table of analogous codes (DODI 1332.39) in determining coding for the condition.  The VA assigned a 10% rating using an analogous 5024-5260 code (tenosynovitis-leg, flexion limitation) based on the VA C&P examination 2 months before separation, citing painful ROM of a major joint.  There was no limitation of flexion or extension that supported a rating under the VASRD diagnostic codes for limitation of motion (5260 or 5261).  The NARSUM examination proximate to separation did not demonstrate the presence of ligamentous instability or laxity (5257), and there was no history of dislocated meniscus or loose body causing frequent locking with recurrent effusions (5258) or history of surgery to remove a meniscus (5259) to support a rating under the respective codes.  There was no fracture, non-union, or malunion of the femur or tibia to support consideration under the respective codes for knee impairment related to long bone conditions (5255, 5262).  However, there was evidence of painful motion with functional loss supporting a 10% rating (based on §4.59, §4.40 and §4.45).  After due deliberation, and considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the Board recommends a disability rating of 10% for the right knee pain from the PFS condition, coded 5099-5024.  

BOARD FINDINGS:  In the matter of the right knee PFS, the Board unanimously recommends a disability rating of 10%, coded 5099-5024 IAW VASRD §4.71a.  There were no other conditions within the Board’s scope of review for consideration.  The Board recommends that the CI’s prior determination be modified as follows, effective as of the date of the prior medical separation:  

CONDITION	VASRD CODE	PERMANENT RATING	
Right Knee Pain 	5099-5024	10%	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20140221, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

SAMR-RB										

MEMORANDUM FOR Commander

SUBJECT:  Department of Defense Physical Disability Board of Review Recommendation for XXXXXXXXXXXXXXXXXX, AR20160008276 (PD201400932)

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, accept the Board’s recommendation to modify the individual’s disability rating to 10% without re-characterization 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:

CF: 
(  ) DoD PDBR
(  ) DVA