RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2014-03445
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20080523

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 for “patellofemoral syndrome, right knee,” with a disability rating of 10%.

CI CONTENTION:  “Please consider all conditions.”  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 based upon a 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 - 20080327	VARD - 20081023	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Patellofemoral Pain Syndrome, Right Knee	5099-5003	10%	Right Knee Chondromalacia	5099-5014	10%	20081003	
PTSD	Not Unfitting	Posttraumatic Stress Disorder	9411	50%	20080926	
Headache Disorder	Not Unfitting	Chronic Headaches	8199-8100	10%	20081003	
Sensory Neuro Hearing Loss	Not Unfitting	Left Ear Hearing Loss	6100	0%	20080924	
		Tinnitus	6260	10%	20080924	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  70%	

ANALYSIS SUMMARY:  

Patellofemoral Pain Syndrome, Right Knee.  According to service treatment records (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s patellofemoral pain, right knee condition began in the winter of 2006 during physical training.  There was immediate throbbing and shooting pain.  Conservative treatment with anti-inflammatory medications, physical therapy and temporary profiles and reducing activity did not result in improvement.  Neuroimaging showed no internal derangement and X-ray indicated mild prepatellar soft tissue swelling.  Orthopedics made the diagnosis of patellofemoral syndrome.  The MEB forwarded patellofemoral pain syndrome, right knee for PEB adjudication.  

The MEB NARSUM examination on 28 February 2008, 3 months prior to separation, noted complaints of continued daily pain in his right knee.  He could not participate in long walks with his dog or with his wife and could not participate in active outdoor sports.  He was taking two medications with moderate relief of pain. Physical examination showed no swelling or discoloration, range of motion (ROM) to 120 degrees with pain on flexion and pain on weight bearing.  He was unable to stand from a squatting position.    

At the 3 October 2008 VA Compensation and Pension (C&P) evaluation, performed 4 months after separation, the CI reported right knee pain was 4/10 in intensity, was weak, stiff, tended to swell and give way, was easily fatigues and lacked endurance.  He was using the same two pain medications he had been using at the time of the NARSUM examination.  Flare-ups occurred spontaneously or with excess walking, lasting 2-48 hours.  He did not require assistive devices.  There was no dislocation or subluxation.  He currently walked up stairs to the third floor to his job site.  Physical examination showed slight swelling and very slight warmth as compared to the left knee.  The right knee flexed to 114 degrees with moderate pain, 1+ retro patellar crepitation with flexion and extension.  There was tenderness medially with manipulation of the lower leg.  The meniscus and anterior cruciate ligaments were normal.  Strength was estimated to be decreased by 30% and further decreased with repetitive motion with no change in ROM.    

The Board directed attention to its rating recommendation based on the above evidence.  The PEB rated the right knee patellofemoral pain syndrome 10%, coded 5099-5003 (degenerative arthritis), citing painful motion.  The VA also rated the right knee chondromalacia condition 10% coded 5099-5014 (osteomalacia), based on the VA C&P examination 4 months after separation, citing painful or limited motion. 

The Board agreed that there was sufficient evidence of painful motion to warrant a 10% rating for the right knee IAW VASRD §4.59 (painful motion) and §4.45 (the joints).  Other pathways to a higher rating were considered, but there was no ankylosis or objective instability, no meniscal removal and no limitation of motion sufficient to warrant any rating higher than 10% for the knee.  After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the Board concluded that there was insufficient cause to recommend a change in the PEB adjudication for the right knee patellofemoral syndrome condition.

Contended Conditions.  PTSD, Headache Disorder and Sensory Neuro hearing loss left ear.  The Board’s main charge is to assess the fairness of the PEB’s determination that PTSD, Headache Disorder and the left ear hearing loss conditions were 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 CI was involved in direct combat while deployed to Iraq in 2005.  Upon return he sought consultation with a civilian counselor to avoid military documentation and was diagnosed with PTSD.  He was later seen by a military psychiatrist who ordered a psychotropic medication to be taken at night.  He remained in therapy and received an S2 profile.  The Commander noted the CI was assigned to the company’s supply room where he did a very effective and capable job.  The Commander noted his performance was limited only by his knee condition.  The headache disorder and sensory neuro left ear hearing loss conditions were not profiled or implicated in the commander’s statement and were not judged to fail retention standards.   All were reviewed and considered by the Board.   There was no performance based evidence from the record that PTSD, headache disorder, sensory neuro left ear hearing conditions significantly interfered with satisfactory duty performance.  

After due deliberation, the Board concluded that there was insufficient cause to recommend a change in the PEB fitness determination for any of the contended conditions and so no additional disability ratings are recommended.  

BOARD FINDINGS:  In the matter of the right knee patellofemoral pain condition and IAW VASRD §4.71a, the Board unanimously recommends no change in the PEB adjudication.  In the matter of the contended PTSD, headache disorder and sensory neuro left ear hearing loss conditions, the Board recommends no change from the PEB determinations 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 20140627, 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

17 NOV 2016

SUBJECT:  Department of Defense Physical Disability Board of Review Recommendation for 
XXXXXXXXXXXXXXXXXX, AR20160017190 (PD201403445)

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:

Enclosure

CF: 
(  ) DoD PDBR
(  ) DVA