RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXXXX	CASE:  PD-2014-03305
BRANCH OF SERVICE:  Army  	SEPARATION DATE:  20070627

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E4 (Chemical Operations Specialist) medically separated for “patellofemoral pain syndrome, left knee,” rated at 0%. 

CI CONTENTION:  The applicant makes no specific contention in her application.  Her 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 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 20070606	VA* - (~8 Mos. Post-Separation) 	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Patellofemoral Pain Syndrome, Left Knee	5099-5003	0%	Patellofemoral Pain Syndrome, Left Knee	5299-5260	10%	20080302	
Other MEB/PEB Conditions x 0 (Not In Scope)	Other x 0 	
RATING:  0%	RATING:  10%	
*Derived from VA Rating Decision (VARD) dated 20080531 (most proximate to date of separation (DOS)).  

ANALYSIS SUMMARY:  

Left Knee Condition.  The service treatment record (STR) documents that the CI sustained a left knee injury during a company run in basic training.  Serial left knee X-rays were normal.  A left knee magnetic resonance imaging (MRI) was normal.  At a physical therapy (PT) encounter, the CI complained of 8/10 left anterior knee pain with pain ranging from 4-9/10 over the previous week.  Pain was exacerbated by prolonged walking (>20 min) and stairs (up>down) and relieved by hot water or ice massage.  The left knee exam revealed darkened posterior stretch marks with no swelling, edema (swelling from excess tissue fluid), or atrophy (wasting or decrease in size).  There was tenderness at the patella, region surrounding patella, medial joint line, lateral joint line, and tibial tuberosity (oblong elevation at proximal anterior tibia where patellar tendon attaches).  The active range-of-motion (ROM) was flexion of “full” (140 normal) and extension of -5 degrees (0 normal).  Lachman (assesses anterior cruciate ligament [ACL]), McMurray (assesses menisci), and valgus/varus stress (assesses medial collateral ligament [MCL]/lateral collateral ligament [LCL]) tests were negative.  Sensation was intact and strength was normal (5/5) except for left knee extension (4+/5).  The assessment listed patellofemoral syndrome ([PFS] symptom complex of anterior knee pain involving the patella).  A PT follow-up documented left knee active ROM flexion of full and extension of -5 degrees.  The narrative summary (NARSUM), 3 months before separation, recounted the history and interventions.  The CI complained of left anterior knee pain of 2-3/10 at baseline (sitting or standing) and 6-8/10 with activity (walking).  Pain was exacerbated by walking, running, and stairs and relieved by rest.  She denied knee swelling or locking.  The CI failed conservative management which included multiple (Motrin, Naprosyn, Lodine) nonsteroidal anti-inflammatory drugs (NSAIDs) and PT.  Her active medication was an NSAID (Motrin).  The examiner restated the findings from the X-rays and MRI.  The left knee exam revealed no ecchymosis (bruising) or edema.  There was tenderness at the MCL and distal femoral condyle (flared prominence).  There was no tenderness at the LCL, joint line, or iliotibial band (lateral thigh thick connective tissue).  Active ROM was full.  The patellar grind (assesses abnormal patellar movement and painful crepitation) test was positive and the drawer (assesses ACL/posterior cruciate ligament [PCL]) and McMurray tests were negative.  The diagnosis listed patellofemoral syndrome.  The VA Compensation and Pension (C&P) exam recounted the history and interventions.  The CI complained of intermittent left knee pain with associated swelling, stiffness, and limited motion.  She denied flare-ups, muscle symptoms, weakness, paralysis, numbness, or paresthesias (abnormal sensation, tingling, burning and prickling).  Pain was exacerbated by activity and was relieved by medication, elevation, and ice.  The active medication was an analgesic (Tylenol) as needed for pain.  The physical exam documented a normal gait and no assistive aid for walking.  The left knee exam revealed tenderness with no atrophy, spasm, swelling, effusion, laxity, ankylosis, or evidence of inflammatory arthritis.  The left knee active ROM was flexion of 90 degrees and extension of 0 degrees.  Strength, sensation, pulses, and deep tendon reflexes were normal and pathologic reflexes were absent.  The diagnosis listed left knee patellofemoral pain syndrome.

The Board directed attention to its rating recommendation based on the available evidence.  The PEB rated the left knee condition 0% (coded 5099-5003).  The PEB cited patellofemoral pain syndrome, pain with standing, and full ROM.  The VA, citing the C&P exam 8 months after separation, rated the left knee condition 10% (coded 5299-5260).  The VA cited patellofemoral pain syndrome, normal X-rays, pain, stiffness, swelling, limited motion, and ROM.  The proximate exams (PT, NARSUM and C&P) did not demonstrate a limitation of motion to support a minimum rating under the limitation of flexion (5260) or extension (5261) codes.  There was no dislocated meniscus (5258), symptomatic removed meniscus (5259), knee ankylosis (5256), knee recurrent subluxation/lateral instability (5257), tibia and fibula nonunion/malunion (5262), or genu recurvatum (5263) for consideration under the respective codes.  Board members agreed that there was sufficient evidence of pain with use, as well objective exam findings, to support a 10% rating considering VASRD §4.59 (painful motion).  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 left knee condition.

BOARD FINDINGS:  In the matter of the left knee condition, the Board unanimously recommends a disability rating of 10%, coded 5299-5260 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 her prior medical separation:  

CONDITION	VASRD CODE	RATING	
Patellofemoral Pain Syndrome, Left Knee	5299-5260	10%	
RATING	10%	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20140623, 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-00), 2900 Crystal Drive, Suite 300, Arlington, VA 22202-3557

SUBJECT: Department of Defense Physical Disability Board of Review Recommendation
for XXXXXXXXXXXXXXXXXXXXX, AR20160004516 (PD201403305)

1 . 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,
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