RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXXXX	CASE:  PD-2014-01532
BRANCH OF SERVICE:  Army	SEPARATION DATE:  20090605

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active E2, Motor Transport Operator, medically separated “bilateral patellofemoral syndrome evaluated as arthritis, degenerative and chronic left leg pain from healing proximal tibial stress fracture,” with a disability rating of 20%.  

CI CONTENTION:  “Due to the short time in service I was not adequately evaluated. It is my belief that because my time in service had really just begun it was thought that I was malingering.”  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 based upon a 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 - 20090521	VARD - 20110114	
Condition	Code	Rating	Condition	Code	Rating	Exam	

Bilateral Patellofemoral Syndrome and Chronic Left Leg Pain from Healing Proximal Tibial Stress Fracture
	5099-5003	20%	Left Knee Tendonitis	5024-5260	10%	20101206	
			Status Post Left Tibia/Fibula Fracture	5299-5262	0%		
			Right Knee Condition	5260	NSC		
COMBINED RATING:  20%	COMBINED RATING OF ALL VA CONDITIONS:  30%	

ANALYSIS SUMMARY:  

Bilateral Knee Condition.  According to service treatment records and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s left leg, left knee pain, and right knee pain began in October 2008 during basic training.  Radiographic studies were normal for the right leg and showed a healing left tibial stress fracture.  The CI was diagnosed with bilateral patellofemoral pain syndrome and healing left tibial stress fracture.  Despite treatment, the bilateral patellofemoral pain syndrome and healing left tibial stress fracture conditions could not be adequately rehabilitated to meet the physical requirements of the CI’s military specialty and the CI was referred for MEB.  The MEB forwarded “chronic bilateral patellofemoral syndrome” and “chronic left leg pain with healing proximal tibial stress fracture” for PEB adjudication.  The narrative summary (NARSUM) noted reports of 2/10 left leg pain which increased with activity.   The CI also reported intermittent knee pain with stairs and prolonged sitting.  The physical examination showed pain limited left knee flexion to 90 degrees (normal 140).  There was tenderness to palpation at bilateral patellofemoral joints and along the left tibia.  Positive patellar grind was noted bilaterally.  At the VA Compensation and Pension examination performed 18 months after separation, the CI reported giving out of the left knee, twice daily, and the right every 3 months.  She reported bilateral knee pain.  On physical examination there was left knee tenderness to palpation.  The right knee was non-tender. Gait, muscle strength, knee range of motion, and neurologic examinations were normal.  

The Board directed its attention to its rating recommendation based on the above evidence.  The PEB rated the bilateral patellofemoral syndrome at 10% for each knee, for a total of 20%, coded 5099-5003 (analogous to degenerative arthritis) citing satisfactory evidence of painful motion.  The left leg pain was subsumed in the pain rating for the left leg.  The VA rated the left knee condition 10% (coded 5024-5260, tenosynovitis-leg limitation of flexion), citing painful motion.  The VA also rated the left leg condition at 0% coded 5299-5262 (Tibia and fibula, impairment of) and did not service connect the right knee condition.  The limitation of motion of the left lower extremity did not meet criteria for a rating under the diagnostic codes for limitation of flexion or extension (5260, 5261). There was no fracture, non-union, or malunion of the femur or tibia for to support consideration under the respective codes for knee impairment related to long bone conditions (5255, 5262) for the right nor the left lower extremity.  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 based on the presence of instability for either lower extremity.  Although there was left leg pain from a healing stress fracture, IAW §4.14 (Avoidance of pyramiding) the Board determined that it would be speculative to differentiate the functional impairment associated with the left knee pain from that chronic left leg pain from the healing left tibial fracture for a separate rating.  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 bilateral patellofemoral pain syndrome and healing left tibial stress condition.  

BOARD FINDINGS:  In the matter of the bilateral patellofemoral pain syndrome and healing left tibial stress condition and IAW VASRD §4.71a, the Board unanimously recommends no change in the PEB adjudications.  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 20140303, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

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 XXXXXXXXXXXXXXXXXXXXX AR20160013473 (PD201401532)

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
(  ) DVA