RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2014-02999
BRANCH OF SERVICE:  Army 	BOARD DATE:  20150513
SEPARATION DATE:  20090319

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E-3 (Basic Trainee) medically separated for patellofemoral syndrome of the left knee.  The condition could not be adequately rehabilitated to meet the physical requirements of his Military Occupational Specialty or satisfy physical fitness standards.  He was issued a permanent L3 profile and referred for a Medical Evaluation Board (MEB).  The “left knee traumatic patellofemoral syndrome” was forwarded to the Physical Evaluation Board (PEB) IAW AR 40-501.  No other condition was submitted by the MEB.  The Informal PEB (IPEB) adjudicated the left knee condition as unfitting, rated 10%, with likely application of the Veterans Affairs Schedule for Rating Disabilities (VASRD).  The CI made no appeals and was medically separated.  

CI CONTENTION:  “CONSIDER ALL CONDITIONS”  “I XXXXX has had constant pain in my knee and lower back for many years, and I have tried to seek help for it but nothing works.” 

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 20090311	VA* - (~5 Mos. Post-Separation) 	
Condition	Code	Rating	Condition	Code	Rating	Exam	
PFS Left…	5099-5003	10%	PFS and Chondromalacia Left…	5299-5260	10%	20090813	
Other x 0 (Not In Scope)	Other x 4	
RATING:  10%	RATING:  10%	
*Derived from VA Rating Decision (VARD) dated 20090917 (most proximate to date of separation (DOS)).  

ANALYSIS SUMMARY:  

Left Patellofemoral Syndrome (PFS).  Review of the record showed that the CI was first evaluated for a 2-day history of left knee pain on 31 October 2008.  He reported that he had fallen onto his left knee.  On examination, the knee was tender and an effusion was documented; otherwise, the examination was normal including the gait and range-of-motion (ROM).  An X-ray was normal.  Four days later, he remained tender, but the effusion absent and the examination remained otherwise normal.  He was evaluated in physical therapy (PT) the next day and again had a normal examination other than tenderness.  An MRI of the left knee was also normal.  In PT on 3 December 2008, he again had tenderness about the knee.  The ROM was now limited to 130 degrees of flexion.  His gait remained normal.  He continued in PT, but was unable to return to training and referred for an MEB.  The narrative summary was dictated by orthopedics on 21 January 2009.  The CI reported that walking was limited to less than one mile.  On examination, the CI had painful motion and flexion limited to 110 degrees with full extension, but no limp.  The knee was stable and without an effusion; crepitus (a non-specific sign of underlying pathology such as early degeneration) was present.  Meniscal signs and atrophy were absent.  At the MEB examination 2 weeks later, examiner noted a restricted ROM and a painful gait.  

At the VA Compensation and Pension (C&P) exam performed 5 months after separation, the CI reported that he did not use an assistive device and that walking was limited to a half block.  The ROM was restricted (below) from guarding; the examiner opined that the actual ROM was greater than what was measured.  Atrophy was not documented.  There was not an effusion, the knee was stable, and signs of meniscal irritation were absent.  Motion was painful in the extremes of range.  At a general C&P 4 days later, the gait was normal.  The goniometric ROM evaluations in evidence which the Board weighed in arriving at its rating recommendation, with documentation of additional ratable criteria, are summarized in the chart below.

Left Knee ROM
(Degrees)	PT ~5 Mo. Pre-Sep	MEB ~2 Mo. Pre-Sep	VA C&P ~5 Mo. Post-Sep	
Flexion (140 Normal)	Full	110	110	
Extension (0 Normal)	Full	0	0	
Comment	Nml gait	Painful motion	Painful motion	
§4.71a Rating	0%	0%	0%	

The Board directed its attention to its rating recommendation based on the above evidence.  The PEB and VA both rated the knee at 10% using the analogous codes 5099-5003 (degenerative arthritis) and 5299-5260 (limitation in flexion), respectively.  The Board found no route to a rating higher than the 10% adjudicated by the PEB and the VA.  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 condition.  

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 left knee condition and IAW VASRD §4.71a, the Board unanimously recommends no change in the PEB adjudication.  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 20140509, 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, AR20150018865 (PD201402999)

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