RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	    CASE:  PD-2014-01791
BRANCH OF SERVICE:  Army	BOARD DATE:  20150226
SEPARATION DATE:  20090625

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E-4, Logistical Specialist, medically separated for patellofemoral pain syndrome.  The condition could not be adequately rehabilitated to meet the physical requirements of his Military Occupational Specialty (MOS).  He was issued a permanent L3 profile and referred for a Medical Evaluation Board (MEB).  The “bilateral knee pain” condition was forwarded to the Physical Evaluation Board (PEB) IAW AR 40-501.  The MEB also identified and forwarded one other condition (adjustment disorder) for PEB adjudication.  The Informal PEB adjudicated “patellofemoral pain syndrome” as unfitting, rated 20%, citing application of the Veterans Affairs Schedule for Rating Disabilities (VASRD).  The remaining condition (adjustment disorder) was determined to be not unfitting.  The CI made no appeals and was medically separated. 

CI CONTENTION:  The CI requested the Board to consider all of his conditions.    

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 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/Naval 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 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: 

IPEB – Dated 20090318	VA* - based on Service Treatment Records (STR)	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Patellofemoral Syndrome	5099-5003	20%	Bilateral Knee Pain	5260	 (NSC)	STR	
Adjustment Disorder	Not Unfitting	PTSD	8411	 (NSC)	STR	
		Depression	9434	 (NSC)	STR	
Other MEB/PEB Conditions  x 0 (Not in Scope)	Other x 2	
RATING:  20%	RATING:  0%	
*Derived from VA Rating Decision (VARD) dated 20091211 (most proximate to date of separation (DOS)).  NOTE: Member was a no-show for his first C&P exams.

ANALYSIS SUMMARY:  

Patellofemoral Syndrome.  Treatment records evidence that the CI presented with right knee pain after a fall in April 2005.  He was treated with activity modification and pain medications.  The records were silent for knee pain until 2006, when the CI underwent physical therapy for a one year history of bilateral knee pain.  A physical therapy note dated 01 March 2006 documented patellofemoral region tenderness to palpation and positive signs of softening of the patella cartilage and inflammation (Clarke’s sign) bilaterally.  The knee motion was documented as normal.  The narrative summary (NARSUM), dated 11 February 2009, noted a history of knee pain which worsened after deployment in August 2007.  In September 2008, the CI was diagnosed with bilateral patella chondropathy and underwent steroid injections.  A magnetic resonance imaging study performed in Germany demonstrated a “slight tear of the posterior horn of the medial meniscus.”  At the time of the NARSUM examination, the CI reported bilateral, constant, pulsating, patella pain with occasional locking of the right patella.  The pain was worse with impact activities, prolonged sitting, and standing.  The CI rated the pain at 6/10 and reported occasional sleep disturbance due to pain.  The physical examination revealed patella tenderness to palpation bilaterally and pain with deep knee flexion.  The gait was normal and there was no evidence of instability.  A diagnosis of bilateral knee pain with patellofemoral pain was rendered.  A physical therapy note, dated 18 February 2009, documented goniometric range-of-motion measurements of right knee flexion to 127 degrees, left knee flexion to 129 degrees, and extension to 0 degrees bilaterally.  At the VA Compensation and Pension (C&P) examination performed 21 months after separation, the CI reported patella pain; rated 5/ 10.  The pain was worse with running and prolonged sitting.  The CI also reported occasional painful knee popping bilaterally.  The physical examination revealed pain free, right knee flexion to 124 degrees; left knee flexion to 125 degrees; and normal extension bilaterally.  There was no swelling, tenderness, instability, or gait abnormality.  

The Board directed its attention to its rating recommendation based on the above evidence.  The PEB adjudicated the patellofemoral pain syndrome of each knee as separately unfitting with a combined disability rating of 20%, coded analogous to degenerative arthritis (5099-5003).  The VA did not service-connect the bilateral knee pain condition.  The Board considered whether there was evidence to support a higher than 10% disability rating for each knee.  There was no evidence for either lower extremity of knee ankylosis (5256), leg limitation of flexion to 30 degrees (5260), leg limitation of extension to 15 degrees 5261), moderate knee abnormality due to bony malunion (5262), or recurrent subluxation/lateral instability (5257) for a 20% rating for each knee.  Considering the totality of the evidence and mindful of VASRD §4.3 (reasonable doubt), members agreed that a disability rating of 20% coded 5099-5003 for the patellofemoral pain syndrome condition was appropriately recommended in this case.  

Contended PEB Conditions.  The PEB adjudicated the adjustment disorder with depressed mood as not constituting a physical disability IAW DoDI 1332 38, E5 1 2 9 4 and is therefore not ratable.  

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 bilateral patellofemoral pain syndrome condition and IAW VASRD §4.71a, the Board unanimously recommends no change in the PEB adjudication.  In the matter of the contended adjustment disorder with depressed mood condition, the Board unanimously recommends no change from the PEB determination as not constituting a physical disability and not ratable IAW DoDI 1332 38, E5 1 2 9 4.  There were no other conditions within the Board’s scope of review for consideration.  

RECOMMENDATION:  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 20140805, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

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 XXXXXXXXXXXXXXXXXX, AR20160008306 (PD201401791)

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