RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXXXXXX	CASE:  PD-2014-01160
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20090403

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E4, Calvary Scout, medically separated for “left knee pain,” with a disability rating of 10%.  

CI CONTENTION:  The applicant contends he was not fairly evaluated.  The applicant’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 - 20090120	VARD - 20090507	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Retropatellar Pain Syndrome Left Knee	5099-5003	10%	Retropatellar Pain Syndrome Left Knee	5099-5014	10%	20090212	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  30%	

ANALYSIS SUMMARY:  

Retropatellar Pain Syndrome Left Knee Condition.  According to the service treatment record (STR) the CI’s condition began as a consequence of twisting the left knee while in specialized training in January 2008.  Radiographic imaging was normal and specialists indicated that surgery was not warranted.  The narrative summary (NARSUM) on 21 October 2008 (5 months prior to separation) recorded complaints of an inability to run and pain after prolonged sitting.  Physical examination noted non-antalgic (non-painful) gait.  Left knee tenderness was present, and ligaments were intact.  The left thigh was minimally smaller than the right and displayed less tone.  Evaluation by physical therapy (PT) on 21 October 2008 noted left knee flexion of 120 degrees (140 degrees normal) and extension 10 degrees more than normal (0 degrees normal).  Painful motion was present.  The examiner indicated that one finding suggested possible anterior cruciate ligament (ACL) insufficiency (positive Lachman test).  When queried about this reported finding, the NARSUM orthopedist re-iterated that the knee ligaments were all stable, as documented by multiple other examiners and magnetic resonance imaging.  

The VA Compensation and Pension (C&P) examination performed 2 months before separation noted a non-antalgic gait.  Left knee flexion was 140 degrees and extension 0 degrees.  There was no change in range-of-motion after 3 repetitions.  Mild painful motion was present.  There was no joint swelling and ligament testing was normal.  

The Board directed attention to its rating recommendation based on the above evidence.  The PEB rated the left knee condition 10%, coded analogously to 5003 (degenerative arthritis), and cited painful motion as the rationale.  The VA also rated the left knee condition 10%, coded 5099-5014 (osteomalacia), citing functional loss due to pain.  There was no limitation of motion which attained a minimum 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) as adjudicated by the PEB and VA.  The examinations proximate to separation did not demonstrate the presence of ligamentous instability or laxity (5257), frequent locking with effusions or any indication of dislocated meniscus or loose body (5258) 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).  There is therefore no VASRD §4.71a route to a rating higher than the 10% adjudicated by the PEB under any applicable code, and no grounds for additional rating for instability.  After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the Board concluded that there was insufficient cause to recommend a change in the PEB adjudication for the left retropatellar pain syndrome condition.  

Contended PEB Conditions.  The allergic rhinitis and depression conditions, which were forwarded as medically acceptable by the MEB, were not specifically adjudicated per the PEB’s DA Form 199; but, the Board judged that this was likely an erroneous omission and should be assumed to constitute a de facto PEB determination that the conditions were not unfitting.  The Board’s main charge is to assess the fairness of this determination.  The allergic rhinitis and depression conditions were not profiled or implicated in the commander’s statement and were not judged to fail retention standards.  Both were reviewed and considered by the Board.   There was no performance based evidence from the record that any of these conditions significantly interfered with satisfactory duty performance.  After due deliberation in consideration of the preponderance of the evidence, the Board concluded that there was insufficient cause to recommend a change in the PEB fitness determination for either of the contended conditions and so no additional disability ratings are recommended.  

BOARD FINDINGS:  In the matter of the left retropatellar pain syndrome condition and IAW VASRD §4.71a, the Board unanimously recommends no change in the PEB adjudication.  In the matter of the contended allergic rhinitis and depression conditions, the Board unanimously recommends no change from the PEB determinations as not unfitting.  There were no other conditions within the Board’s scope of review for consideration.  

The Board, therefore, recommends that there be no re-characterization of the CI’s disability and separation determination.  

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20140306, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

MEMORANDUM FOR Commander

SUBJECT:   Department of Defense Physical Disability Board of Review Recommendation for XXXXXXXXXXXXXXXXXXXXXXX AR20160005818  (PD201401160)

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 and hereby deny the individual's application.
This decision is final.  The individual concerned, counsel (if any), and any Members of Congress who have shown interest in this application have been notified of this decision by mail.

BY ORDER OF THE SECRETARY OF THE ARMY:

Enclosure 
CF:
( ) DoD PDBR
( ) OVA