RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXXX	CASE:  PD-2014-03161
BRANCH OF SERVICE:  Army	SEPARATION DATE:  20080207

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E-3 (Light Wheel Vehicle Mechanic) medically separated for “bilateral patellofemoral pain syndrome,” rated at 0%.  

CI CONTENTION:  “Please consider all conditions.”

SCOPE OF REVIEW:  The Board’s scope of review is defined in DoDI 6040.44.  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 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:  

Admin Corr PEB – Dated 20090304	VA* - (~2 Mos. Pre-Separation)	
Condition	Code	Rating	Condition	Code	Rating	
PFS, Left Knee	5099-5003	10%	PFS, Left Knee	5299-5261	0%	
PFS, Right Knee	5099-5003	10%	PFS, Right Knee	5299-5261	0%	
Cubital Tunnel Syndrome	Not Unfitting	CTS, Left Elbow	8514	0%	
Other MEB/PEB Conditions x 0 (Not In Scope)	Other x 0	
RATING:  20%	RATING:  0%	
*Derived from VA Rating Decision (VARD) dated 20080725 (most proximate to date of separation (DOS)).  

ANALYSIS SUMMARY:  

Bilateral Knee Condition. The record shows that the CI developed retro-patellar pain, right greater than left, during the first few weeks of accession.  There was no trauma other than the stresses of basic training.  He was treated with medications, profiles, and physical therapy (PT) and able to complete basic and advanced training, but continued to have pain.  X-rays were normal as was a magnetic resonance imaging (MRI) of the right knee.  An examination in PT on 16 May 2007 was remarkable for mild bilateral atrophy of the quadriceps muscles (anterior thigh), but the range-of-motion (ROM) was normal and the knee stable.  He had a normal examination in Orthopedics 2 days later, but could not meet duty requirements due to persistent knee pain.  At the MEB examination on 17 October 2007, the CI reported constant bilateral knee pain and that his knees “gave out” a few times a week.   The MEB physical exam noted that the knees were painful to palpation and motion.  The knees were otherwise unremarkable and the ROM full.  The narrative summary (NARSUM) was dated 9 November 2007.  The CI reported right greater than left knee pain aggravated by activity.  He had recently been given a cane, used as needed, for ambulation.  He was using a right knee brace and favored that side walking.  The ROM was full.  He was tender to palpation and grinding of the kneecap painful (right greater than left).  The knee was stable and signs of meniscal irritation absent.  He was diagnosed with bilateral PFS.  At the VA Compensation and Pension (C&P) exam performed 2 months before separation, the CI reported continued pain.  He had a cane, but used it infrequently and his gait was normal.  The examination was essentially normal with full ROM without pain, no instability or meniscal signs, swelling, or tenderness.  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.

Knee ROM
(Degrees)	PT ~9 Mo. Pre-Sep	MEB ~3 Mo. Pre-Sep	VA C&P ~2 Mo. Pre-Sep	
	Left	Right	Left	Right	Left	Right	
Flexion (140 Normal)	“Normal”	“Normal”	“FROM”	“FROM”	140	140	
Extension (0 Normal)					0	0	
Comment	Painful motion not recorded	Painful motion	Painful motion not present	
§4.71a Rating	0%	0%	10%	10%	0%	0%	

The Board directed its attention to its rating recommendation based on the above evidence.  The PEB rated each knee at 10%, coded 5099-5003 (analogous to degenerative arthritis), citing painful motion.  The VA initially rated each knee at 0% based on the C&P examination, coded 5299-5261 (analogous to limitation in extension), but later increased each to 10% based on post-separation VA records and lay testimony.  The Board considered the findings and found no route to a higher rating.  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 bilateral PFS condition.  

Contended PEB Conditions.  The Board’s main charge is to assess the fairness of the PEB’s determination that the cubital tunnel syndrome (CTS) 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 CTS was not profiled, implicated in the commander’s statement, or judged to fail retention standards.  The CI first reported it while in the MEB and had a normal neurological examination.  It was reviewed and considered by the Board.   There was no performance based evidence from the record that it 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 CTS condition and so no additional disability rating is recommended.

BOARD FINDINGS:  In the matter of the bilateral patellofemoral pain syndrome and IAW VASRD §4.71a, the Board unanimously recommends no change in the PEB adjudication.  In the matter of the contended cubital tunnel syndrome conditions, 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 20140617, 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 XXX, Arlington, VA  22202-3557

SUBJECT:  Department of Defense Physical Disability Board of Review Recommendation for XXXXXXXXXXXXXXXXXXXX, AR20160004081 (PD2014-03161)

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: