RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXX	CASE:  PD-2014-01872
BRANCH OF SERVICE:  Army	BOARD DATE:  20140724
SEPARATION DATE:  20030315

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty PV1/E-1 (19K/Armor) medically separated for chronic pain due to right patellofemoral syndrome, lateral femoral condyle and patellar stress fractures.  The CI could not be adequately rehabilitated to meet the physical requirements of his Military Occupational Specialty.  His profile allowed for an alternate aerobic event to satisfy physical fitness standards.  He was issued a permanent L3 profile and referred for a Medical Evaluation Board (MEB).  The right knee condition, characterized as “right patellofemoral syndrome” and “lateral femoral condyle as well as patellar stress fractures,” was forwarded to the Physical Evaluation Board (PEB) IAW AR 40-501.  No other conditions were submitted by the MEB.  The Informal PEB adjudicated “chronic pain due to right patellofemoral syndrome, lateral femoral condyle and patellar stress fracture” as unfitting, rated 0%, referencing the US Army Physical Disability Agency (USAPDA) pain policy.  The CI made no appeals and was medically separated.

CI CONTENTION:  “Please consider all 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 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 condition is addressed below.  Members judged that a not unfitting adjudication of a left knee condition was implied by the PEB.  The left knee was specified sufficiently in the application to meet the DoDI 6040.44 scope requirements and is accordingly addressed below.  No additional conditions 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 20030218	VA - Based on Service Treatment Records (STR)	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Pain due to Right Patellofemoral Syndrome, Lateral Femoral Condyle and Patellar Stress Fracture	5099-5003	0%	S/P Stress Fracture, Right  Lateral Femoral Condyle (Including Right Knee Patellofemoral Syndrome)	5299-5255	10%	STR	
Other x 0 (Not in Scope)	Other x 2		
Rating: 0%	Combined:  20%	
Derived from VA Rating Decision (VARD) dated 20030315 (most proximate to date of separation [DOS]).

ANALYSIS SUMMARY:

Chronic Right Knee Pain Condition.  The CI first presented with right knee pain in October 2002.  Pain was present for a week and was not associated with a history of trauma.  Recurrent right knee pain was evaluated with an X-ray, which showed a possible stress fracture of the right tibia.  A bone scan in November 2002 suggested the presence of a lateral femoral condyle stress fracture (i.e. located at the upper front part of the knee joint towards the outside) and did not confirm the presence of a right tibial stress fracture.  At the narrative summary (NARSUM) evaluation on 29 January 2003 (6 weeks prior to separation), the CI’s chief complaint was right leg pain.  He complained of increased pain if he bent his knee or with squatting, climbing stairs and kneeling.  Pain occurred from the right thigh to the shin.  Physical exam showed pain with compression of the patella, tenderness along the anterior-medial thigh and tenderness of the lateral femoral condyle.  At the MEB separation exam on 5 February 2003, the CI reported “stress fractures in right leg.”  Examination showed painful motion of the knee.

The Board directs attention to its rating recommendation based on the above evidence.  While the analogous 5003 code (degenerative arthritis) used by the PEB was a reasonable option, there was no measured range of knee motion in evidence upon which to base a rating under this code.  Nevertheless, Board members agreed there was sufficient evidence of painful motion (VASRD §4.59) to justify a 10% rating.  The VA assigned a 10% rating under an analogous 5255 code (impairment of femur with malunion).  Board members agreed that “slight” knee disability best described the evidence and therefore the next higher 20% rating was not supported via this coding pathway.  After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the Board recommends a disability rating of 10% for the chronic right knee pain condition, coded 5099-5003.

Contended PEB Conditions.  The Board’s main charge is to assess the fairness of the PEB’s determination that a left knee stress fracture condition was not unfitting.  The Board’s threshold for countering fitness determinations is higher than the VASRD §4.3 (reasonable doubt) standard used for its rating recommendations, but remains adherent to the DoDI 6040.44 “fair and equitable” standard.  Although a bone scan indicated the possible presence of a left lateral femoral condylar stress fracture and the NARSUM examiner reported tenderness in that area, there was no indication in the record of left knee complaints.  At the separation and the NARSUM exams, the CI only complained of right-sided pain.  The left knee condition was not profiled and was not judged to fail retention standards.  It was reviewed and considered by the Board.  There was no performance based evidence from the record that this condition 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 the left knee stress fracture condition and so no additional disability rating is recommended.

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.  As discussed above, PEB reliance on the USAPDA pain policy for rating chronic pain due to right patellofemoral syndrome, lateral femoral condyle and patellar stress fracture was operant in this case and the condition was adjudicated independently of that policy by the Board.  In the matter of the chronic pain due to right patellofemoral syndrome, lateral femoral condyle and patellar stress fracture condition, the Board unanimously recommends a disability rating of 10%, coded 5099-5003, IAW VASRD §4.71a.  In the matter of the contended left knee stress fracture condition, the Board unanimously recommends no change from the PEB determination of not unfitting.  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	
Chronic Pain due to Right Patellofemoral Syndrome, Lateral Femoral Condyle and Patellar Stress Fracture	5099-5003	10%	
RATING	10%	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20140501, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans’ Affairs Treatment Record

		
XXXXXXXXXXXXXXXXX
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 XXXXXXXXXXXXXXXXX, AR20150006353 (PD201401872)

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						     XXXXXXXXXXXXXXXXX
						     Deputy Assistant Secretary of the Army
						         (Review Boards)

CF: 
(  ) DoD PDBR
(  ) DVA