RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXXXX	CASE:  PD-2014-03430
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20050115

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

CI CONTENTION:  The applicant makes no specific contention in his application.  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 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 - 20041006	VARD - 20050207	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Retropatellar Pain Syndrome, Right Knee	5099-5003	0%	Right Knee Retropatellar Pain Syndrome (RPPS) 	5299-5024	10%	STR	
COMBINED RATING:  0%	COMBINED RATING OF ALL VA CONDITIONS:  10%	

ANALYSIS SUMMARY:  

Retropatellar Pain Syndrome, Right Knee.  According to service treatment records and the Medical Evaluation Board (MEB) narrative summary (NARSUM) the CI’s right knee condition began in 2001 while doing unit physical training.  There was waxing and waning of the pain but in the several months prior to the MEB the pain increased and interfered with most activities.  A clinic examination, 7 April 2004, noted some discomfort with examination but there was no swelling, crepitus, or ligament instability.  The diagnosis was patellofemoral syndrome.  Magnetic resonance imaging (MRI) showed mild degenerative change of the meniscus without tear.  The MRI was otherwise normal including intact ligaments.  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 was referred for a MEB.  At the time of the MEB orthopedic NARSUM examination, 30 July 2004, the CI reported persistent right knee pain interfering with most activities.  He denied episodes of locking or give-way symptoms.  On examination, there was tenderness in the inner aspect of the knee.  The patella (knee cap) tracked normally with motion and there was no muscle atrophy (loss of muscle mass due to decreased use) of the quadriceps muscle.  Tests for meniscus problems were negative.  Range-of-motion was “complete extension” to 135 degrees of flexion.  The MEB NARSUM addendum, 27 September 2004, reported a repeat range of motion examination with repetition showing 5 degrees loss of extension and flexion to 105 degrees.  There was no VA Compensation and Pension examination proximate to separation and the VA based their service connected rating on the service medical records.  The Board directed attention to its rating recommendation based on the above evidence.  The PEB rated the right knee condition 0% coded 5099-5003, degenerative arthritis.  The VA rated the right knee condition 10% coded 5299-5024, tenosynovitis, citing service medical records and painful and limited motion of a major joint.  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.  

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 his prior medical separation:  

CONDITION	VASRD CODE	RATING	
Retropatellar Pain Syndrome, Right Knee	5099-5003	10%	
RATING	10%	

The following documentary evidence was considered:
Exhibit A.  DD Form 294, dated 20140715, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

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 AR20160008015 (PD201403430)

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