RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXXX	     CASE:  PD-2014-01881
BRANCH OF SERVICE:  Army                                                                  SEPARATION DATE:  20090813

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E4, Signal Support Systems Specialist, medically separated for “patellofemoral syndrome, right” and “patellofemoral syndrome, left” with disability ratings of 10% and 10%, respectively, with a combined disability rating of 20%.

CI CONTENTION:  The CI asserts that he was rated for posttraumatic stress disorder at 0 percent at separation and the Veterans Administration (VA) rated this condition at 70 percent.  He further contends the service rated his both knees at 20 percent and the VA rated this condition at 30 percent for each knee.  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 - 20090701	VARD - 20091202 	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Patellofemoral Syndrome (Right)	5099-5003	10%	Patellofemoral Syndrome Right Knee	5003-5260	0%	20091014	
Patellofemoral Syndrome (Left)	5099-5003	10%	Patellofemoral Syndrome Left Knee	5003-5260	0%	20091014	
Posttraumatic Stress Disorder (PTSD)	Not Unfitting	Posttraumatic Stress Disorder	9411	30%	STR	
COMBINED RATING:  20%	COMBINED RATING OF ALL VA CONDITIONS:  50%	

ANALYSIS SUMMARY:  

Patellofemoral Syndrome (Right).  Service treatment records (STR) note the CI deployed to Iraq from October 2006-January 2008.  In November 2007, he jumped from a truck, fell, and both knees buckled and his 150 pound machine gun hit the top of both knees.  He experienced sharp pain and swelling.  After redeployment he performed a jump at the airborne school and landed on both knees.  He was unable to walk, was evaluated by a paramedic and returned to duty.  He continued to complain of bilateral knee pain.  In April 2008 a diagnosis of patellofemoral (PFF) syndrome was rendered.  Despite conservative treatment, the knee pain remained and he received a knee brace in October 2008.  He was evaluated by an orthopedic surgeon who concurred with the diagnosis of PFF.  Neuroimaging of both knees was normal.  The commander’s statement noted the CI did not cause any problems, interactions with peers was normal, does what he is told, acts according to his profiles, and had not taken a physical training test since being assigned to the Rear Detachment.

The narrative summary (NARSUM), dated June 2009, noted the CI had not been able to perform Army Physical Fitness Test since 2005.  He was unable to move with a fighting load, construct an individual fighting position, and perform rushes under fire.  He had daily flare-ups of the bilateral knee pain with pain at rest of 6/10 and pain with walking.  Running, cold weather and walking up and down stairs worsened the pain to 8-9/10.  Resting, stretching, sitting and rubbing the knee relieved the pain.  Physical exam, dated 21 January 2009, showed a normal gait and no deformity.  Pulses were normal, muscle strength was 5/5 and the peripheral nervous system was intact.  There was no involuntary movement and no muscle atrophy.  Muscle tone was normal and strong.  X-rays of both knees in August 2009 were normal.  Range of motion (ROM) of the right knee showed flexion to 135 degrees (normal 140 degrees) and extension to 0 degrees (normal) with pain and minimal fluid knee.  

At the VA Compensation and Pension (C&P) examination performed approximately 2 months after separation, the CI reported weakness, stiffness, giving way, lack of endurance and pain.  He denied heat, tenderness, subluxation, and dislocation.  He had flare-ups up to 3 times per day and each time lasting 1 hour, and precipitated by physical activity and relieved by rest.  He reported no hospitalization, surgery, overall functional impairment or incapacitation.  He was unable to climb stairs, walk and push a lawn mower due to back and knees.  He was not employed and last employment was August 2009.  Physical examination showed normal gait and posture without an assistive device.  Left and right ROM showed flexion to 140 degrees and extension to 0 degrees (both normal.)  There was no tenderness, swelling, instability, weakness, malalignment, crepitus, locking pain, deformity or subluxation. 

Patellofemoral Syndrome (Left).  History of illness, NARSUM, commander’s statement and C&P examination are as described for the patellofemoral syndrome (right) condition with the following exceptions:  NARSUM examination of the left knee:  ROM of the left knee showed flexion to 115 degrees and extension to 4 degrees with pain.  There was bilateral crepitus (popping) below the patella bilaterally, worse in the left knee than the right.  

The Board directed its attention to its rating recommendation based on the above evidence.  The PEB assigned a 10% rating under an analogous 5003 code (degenerative arthritis).  Using an analogous code 5299-5260 (leg; limitation of flexion), the VA also assigned a 10% rating citing painful motion.  While there was no evidence of compensable limitation of motion, the Board agreed that the PEB’s 10% rating was supported under the 5003 coding pathway by sufficient evidence of painful motion and or crepitation (§4.59.)  Absent surgical intervention, instability or abnormal boney union, alternative knee codes of 5258, 5257 and 5262 were not applicable.  All members agreed that there were no available alternative coding options which were advantageous to the CI’s current 10% 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 patellofemoral syndrome right or left conditions.  

Contended PTSD Condition.  On the Post-Deployment Re-Assessment, dated June 2008, the CI endorsed nightmares, avoidance, hypervigilance, excessive drinking, detachment, and daily depression and little pleasure in doing things.  He expressed interest in seeking assistance for his emotional issues. The psychiatric addendum noted the CI was treated in the Restoration and Resilience Clinic for the past 6 months for symptoms of PTSD with remarkable success.  Medications over the past month had marked efficacy.  He was taking a medication for depression and one for sleep.  Mental status examination was essentially normal with an “anxious mood.”  The Developmental Counseling Form noted the CI was at low risk for violence/depression.  The commander noted the CI followed orders, had good relationships with peers, and did not cause problems.  

The PTSD condition was not profiled or implicated in the commander’s statement and was not judged to fail retention standards.   The condition was reviewed and considered by the Board.   There was no performance based evidence from the record that PTSD 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 PTSD contended condition and so no additional disability rating are recommended.

BOARD FINDINGS:  In the matter of the patellofemoral syndrome (right) condition and IAW VASRD §4.71a, the Board unanimously recommends no change in the PEB adjudication.  In the matter of the patellofemoral syndrome (left) condition and IAW VASRD §4.71a, the Board unanimously recommends no change in the PEB adjudication.  In the matter of the contended PTSD condition, the Board unanimously recommends no change from the PEB determination 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 20140407, 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 XXXXXXXXXXXXXXXXXXXX, AR20160007466 (PD201401881)

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