RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXX	CASE:  PD-2014-03406
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20070625

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E4, Infantryman, medically separated “left knee patellofemoral syndrome,” with a disability rating of 0%.  

CI CONTENTION:  The applicant requests consideration of all conditions in his application.  The CI’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 - 20070530	VARD - 20071116	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Patellofemoral Syndrome, Left Knee	5099-5003	0%	Degenerative Joint Disease Left Knee	5010-5261	10%	20070807	
COMBINED RATING:  0%	COMBINED RATING OF ALL VA CONDITIONS:  10%	

ANALYSIS SUMMARY:  

Patellofemoral Syndrome Left Knee.  According to service treatment records and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s left knee condition first began in December 2005 after running.  It was reinjured during a foot patrol while deployed in September 2006. There was no surgical indication.  Despite treatment, the CI’s knee condition could not be adequately rehabilitated to meet the physical requirements of the CI’s military specialty and so he was referred for an MEB.  At the time of the primary care clinic appointment on 11 March 2007, 3 months before separation, the CI reported 6 months of left knee pain. Examination showed left knee tenderness, but no swelling or redness.  Full range of motion (ROM) was present.  ROM measurements by physical therapy on 30 April 2007 (2 months before separation) showed left knee flexion of 135 degrees after repetition (normal 140 degrees) and extension of 0 degrees (normal 0 degrees).  Painful motion was present.

The MEB examination (recorded on DD Form 2807 and 2808) dated 10 May 2007 (2 months before separation) showed painful left knee motion and tenderness.  At the MEB NARSUM exam dated 17 May 2007 the CI reported constant pain in his left knee aggravated by moving it the wrong way, lifting heavy objects, carrying over 20 pounds, running, or kneeling.   Physical exam noted “full painless ROM” of the left knee, although it also recorded pain during strength testing and during patella grind testing.  Tenderness and crepitus were present, but there was no ligamentous instability.

At the VA Compensation and Pension (C&P) examination on 7 August 2007 (a month after separation) the CI reported left knee pain without flare-ups.  The exam recorded a normal gait at one point, but then a slight limp was also noted.  Painful motion was present. Left knee flexion was 130 degrees and extension was 0 degrees.  There was no change in ROM after repetitive motion.

The Board directed attention to its rating recommendation based on the above evidence.  The PEB rated the left knee condition 0% under an analogous code of 5003 (degenerative arthritis), with likely application of the US Army Physical Disability Agency pain policy.  The VA rated the left knee condition 10% using code 5010-5261 (arthritis due to trauma; leg limitation of flexion), citing painful limitation of motion as the rating rationale.  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), or 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 recommended a disability rating of 10% for the left knee condition, coded 5099-5003.  

BOARD FINDINGS:  In the matter of the left 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 his prior medical separation:  

CONDITION	VASRD CODE	RATING	
Patellofemoral Syndrome Left Knee 	5099-5003	10%	
RATING	10%	

The following documentary evidence was considered:
Exhibit A.  DD Form 294, dated 20140701, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

AR20160008009, XXXXXXXXXXXXXXXXXXX

XXXXXXXXXXXXXXXXXXX

Dear XXXXXXXXXXXXXXXXXXX:

The Department of Defense Physical Disability Board of Review (DoD PDBR) reviewed your application and found that your disability rating should be modified but not to the degree that would justify changing your separation for disability with severance pay to a permanent retirement with disability.   I have reviewed the Board's recommendation and record of proceedings (copy enclosed) and I accept its recommendation.  This will not result in any change to your separation document or the amount of severance pay.  A copy of this decision will be filed with your Physical Evaluation Board records.  I regret that the facts of the case did not provide you with the outcome you may have desired.

This decision is final.  Recourse within the Department of Defense or the Department of the Army is exhausted; however, you have the option to seek relief by filing suit in a court of appropriate jurisdiction.

A copy of this decision has also been provided to the Department of Veterans Affairs.

Sincerely,