RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXXXX	CASE:  PD-2014-03279
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20030623

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E3 (Cavalry Scout) medically separated by the Informal Physical Evaluation Board for “patellofemoral pain, right knee” with a disability rating of 0%.  

CI CONTENTION:  The applicant requests the Board consider all conditions.  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 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 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 - 20030605	VARD - 2030624	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Patellofemoral Pain, Right Knee	5099-5003	0%	Patellofemoral Syndrome, Right Knee	5099-5014	10%	STR	
COMBINED RATING:  0%	COMBINED RATING OF ALL VA CONDITIONS:  10%	

ANALYSIS SUMMARY:  

Patellofemoral Pain, Right Knee.  According to service treatment records and the MEB narrative summary (NARSUM), the CI’s right knee condition began in August 2002 with running.  Radiographic studies were mostly negative, but a bone scan showed periosteal reactions (irritated bones) of both knees.  There was no surgical indication.  Despite treatment, the CI’s right knee condition could not be adequately rehabilitated to meet the physical requirements of the CI’s military specialty and was referred for a Medical Evaluation Board (MEB).  

At the time of the physical therapy clinic appointment on 21 April 2003, 2 months prior to separation, the examiner noted 8 months of right knee pain due to running, road marching, or squatting.  On examination there was full range-of-motion (ROM) with mild crepitus, quad atrophy, right knee pain, but no instability.  ROM was 0 degrees of extension and 130 degrees of flexion (normal ROM is 0-140 degrees).  At the MEB NARSUM exam, 2 May 2003, 2 months prior to separation, the CI reported right knee pain with running and going up stairs.  Physical exam documented positive knee pain, crepitus with painful motion, and no knee instability or swelling.  ROM was 0 degrees of extension and 130 degrees of flexion.  There was no VA Compensation and Pension (C&P) examination conducted proximate to the CI’s separation from the Army.  

The Board directed attention to its rating recommendation based on the above evidence.  The PEB assigned a 0% rating under an analogous 5099-5003 code (degenerative arthritis), citing the US Army Physical Disability Agency (USAPDA) pain policy (AR 635-40).  The VA assigned a 10% rating using an analogous 5099-5014 code (osteomalacia), citing painful motion and limitation of motion based on the MEB exam citing patellar crepitus and painful motion.  There was no limitation of flexion or extension that supported a minimum rating under the VASRD diagnostic codes for limitation of motion (5260 or 5261).  The examinations proximate to separation did not demonstrate the presence of ligamentous instability or laxity (5257), frequent locking with effusions or any indication of dislocated meniscus or loose body (5258), to support a rating under the respective codes.  There was no fracture, non-union, or malunion of the femur or tibia to support consideration under the respective codes for knee impairment related to long bone conditions (5255, 5262).  However, there was evidence of painful motion with functional loss supporting a 10% rating (based on §4.59, §4.40 and §4.45).  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 right knee condition, coded 5099-5003.  

BOARD FINDINGS:

In the matter of the right knee condition, the Board unanimously recommends a disability rating of 10%, coded 5099-5003 IAW VASRD §4.71a.  There were no other conditions within the Board’s scope of review for consideration.  The Board recommends that the CI’s prior determination be modified as follows, effective as of the date of the prior to medical separation:  

CONDITION	VASRD CODE	PERMANENT RATING	
Right Knee Pain	5099-5003	10%	
RATING	10%	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20140612, 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 XXXXXXXXXXXXXXXXXXXXX, AR20160004508 (PD201403279)

1. I have reviewed the enclosed Department of Defense Physica! 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,
accept the Board's recommendation to modify the individual's disability rating to 10%
without re-characterization 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:

CF:
( ) DoD PDBR
()DVA