RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXXX	CASE:  PD-2014-01923
BRANCH OF SERVICE:  Army  	SEPARATION DATE:  20080621

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty O1, Officer Basic Student, medically separated for left knee pain, with a disability rating of 10%. 

CI CONTENTION:  “Original rating was 10% for a knee injury and did not take into consideration other conditions which were rated higher by the VA.” 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 - 20080411	VARD - 20090206	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Left Knee Patellofemoral Syndrome	5099-5003	10%	Patellofemoral Syndrome, Left Knee	5260	10%	20080924	
Pes Planus	Not Unfitting	Hallux Abducto Valgus (Bunion), Right Foot, also Claimed as Plantar Fasciitis	5280	10%	20080924	
		Plantar Fasciitis, Left Foot	5099-5020	0%	20080924	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  30%	

ANALYSIS SUMMARY:  

Left Knee Patellofemoral Syndrome.  The record shows that the CI was first evaluated for left knee pain on 10 August 2006 reporting that he had hit his knee 9 days earlier.  His knee was tender, but the examination otherwise unremarkable.  He was diagnosed with a contusion (bruise) and treated with medications and limited duty.  He continued to have pain and was referred to physical therapy (PT) with the diagnosis of patello-femoral syndrome (PFS).  Despite treatment, his pain persisted.  An X-ray on 3 May 2007 was normal.  Magnetic resonance imaging (MRI) on 5 October 2007 showed an abnormality of the patellar (kneecap) tendon, but otherwise was normal.  He was then referred to orthopedics for evaluation.  He reported a 9-month history of pain since a hyperextension injury while running in August 2006.  On examination, the patella was tender to compression, but the knee was stable and without signs of meniscal (cartilage cushions inside the knee) irritation.  He was diagnosed with PFS and inflammation of the patellar tendon.  His medications were changed.  At a follow-up appointment on 29 January 2008, he was noted to have exhausted conservative (non-surgical) treatment and a Medical Evaluation Board (MEB) was recommended.  The patella remained tender to compression, but the remainder of the examination including the range-of-motion (ROM) was normal.  At the MEB examination on 31 March 2008, the CI reported that he was unable to run or bear much weight on his left knee.  On the MEB physical examination, flexion was limited as charted below.  His neurological examination was checked “normal.”  The narrative summary (NARSUM) was dictated the same day.  It noted that conservative treatment including PT, medications, and a brace had failed.  On examination, he had a painful gait and his left leg gave out during a jogging test.  The ROM was limited and painful and is charted below.  The knee was stable.  At the VA Compensation and Pension (C&P) examination performed on 24 September 2008, 3 months after separation, the CI reported that he developed right knee pain in August 2006.  He was able to walk his dogs, but had difficulty with sustained walking on a treadmill.  He used a soft brace with metal stays.  On examination, he was able to get on and off the examination table and had a normal gait.  His strength was noted to be intact.  Tenderness was present about the kneecap.  The knee was stable.  

The PEB and VA both rated the knee at 10%, coded 5099-5003 (analogous to degenerative arthritis) and 5260 (limitation in flexion).  The Board considered the evidence and found no route to a rating higher than the 10% the PEB adjudicated.  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 PFS condition.  

Contended PEB Conditions
The Board’s main charge is to assess the fairness of the PEB’s determination that pes planus was not unfitting.  The Board’s threshold for countering fitness determinations requires a preponderance of evidence, but remains adherent to the DoDI 6040.44 “fair and equitable” standard.  The pes planus condition was not profiled, specifically or implicated in the commander’s statement, or judged to fail retention standards.  It was reviewed and considered by the Board.  The VA C&P noted no significant occupational affects from a foot condition.  There was no performance based evidence from the record that this condition significantly interfered with satisfactory duty performance at separation.  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 contended pes planus condition and so no additional disability rating is recommended.

BOARD FINDINGS.  In the matter of the left knee PFS condition and IAW VASRD §4.71a, the Board unanimously recommends no change in the PEB adjudication.  In the matter of the contended pes planus 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 20140222, 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, AR20160006079 (PD201401923)

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