RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2014-04199
BRANCH OF SERVICE:  Army	SEPARATION DATE:  20081127

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E4, Health Care Specialist, medically separated for “left knee patellofemoral dysfunction” 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 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 -  20081010	VARD - 20090901	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Left Knee Patellofemoral Dysfunction…	5099-5003	10%	Recurrent Dislocation, Left Knee	5257-5010	10%	20090330	
Right Shoulder Sprain	Not Unfitting	Chronic Sprain, R Shoulder	5201-5010	10%	20090330	
Myopia		Myopia	6099-6080	NSC*	20090330	
Flat Feet		Bilateral Pes Planus	5276	NSC	20090330	
Migraines		Migraine Headaches	8100	10%	20090330	
PTSD		PTSD	9411	30%	20090515	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  50%	

ANALYSIS SUMMARY:

Left Knee Patellofemoral Dysfunction.  According to service treatment records (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s left knee condition began in January 2004 when he miss stepped and dislocated his left patella (kneecap).  An MRI confirmed a tear of a ligament attaching to the patella, but was otherwise essentially normal.  The CI was treated with aspiration of fluid in the knee joint and a reduction (putting the knee cap back in place).  He also underwent physical therapy (PT), duty restrictions, and medications.  While he showed improved function and was able to return to duty, his pain persisted.  At the time of the orthopedic clinic appointment on 14 March 2008, the examiner noted patellofemoral joint dysfunction and pain.  The knee was stable though and signs of meniscal irritation negative.  The examiner stated that surgery would have limited benefit.  At a follow-up appointment 3 weeks later, an MEB was recommended.

At the MEB examination recorded on DD Form 2808 Report of Medical Examination dated 23 June 2008, approximately 5 months prior to separation, the physical examination showed left knee lateral tracking and a palpable click.  The MEB NARSUM examination was performed by PT on 21 July 2008, 2 months prior to separation.  The CI reported that he was unable to wear tactical gear or to run.  On the physical examination, the knee was stable but tender and with crepitus (an audible or sensible sensation of grating).  The range of motion (ROM) was flexion of 134 degrees (normal 140) and extension of 0 (normal 0) with painful motion.

At the VA Compensation and Pension (C&P) examination in March 2009, performed approximately 4 months after separation, the CI reported that he had recurrent dislocation of his left knee which was usually caused by prolonged walking greater than one quarter of a mile.  He also reported occasional locking and occasional giving way with instability and pain rated at 8/10.  On examination, the gait and posture were normal.  The ROM was noted as flexion of 134 degrees and extension of 0 with painful motion.  Atrophy was absent.  He could not hop or squat on his left.  The ligaments were intact and signs of meniscal irritation (cartilage cushions in the knee) were absent.  However, the examiner also noted that there was instability in the knee which is not consistent with the recorded examination and reduced the probative value of this comment for rating.  A normal gait is noted to be consistent with a stable or near stable knee vice an unstable knee.

The Board directed attention to its rating recommendation based on the above evidence.  The PEB rated the left knee condition 10%, analogously coded 5099-5003 (degenerative arthritis), citing limitation of motion of one major joint.  The VA also rated the left knee condition 10%, analogously coded 5257-5003 (knee, other impairment, recurrent subluxation or lateral instability - arthritis due to trauma) based on the VA C&P examination 4 months after separation, citing recurrent dislocation with painful motion.  The Board agreed there was no limitation of motion which supported a rating under the diagnostic codes for limitation of flexion or extension (5260, 5261); however, there was evidence of painful motion with functional loss supporting a 10% rating (based on §4.59, §4.40 and §4.45) as adjudicated by the PEB.  The Board found no route to a rating higher than the 10% under any applicable code; the totality of evidence showed a stable knee and does not support an additional rating based on the presence of instability.  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 left knee condition.

Contended PEB Conditions:  Right Shoulder Sprain, Myopia, Flat Feet, Migraines and PTSD.  The Board’s main charge is to assess the fairness of the PEB’s determination that the contended conditions were not unfitting.  These conditions were not profiled or implicated in the commander’s statement and were not judged to fail retention standards.  There was no performance-based evidence from the record that the conditions significantly interfered with satisfactory duty performance at separation.  After due deliberation, and in consideration of the preponderance of the evidence, the Board concluded that there was insufficient cause to recommend a change in the PEB fitness determination for the contended conditions and so no additional disability ratings are recommended.

BOARD FINDINGS:  In the matter of the left knee patellofemoral dysfunction condition and IAW VASRD §4.71a, the Board unanimously recommends no change in the PEB adjudication.  In the matter of the contended right shoulder, myopia, flat feet, migraines and PTSD conditions, the Board unanimously 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 20141004, 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

07 DEC 2016

SUBJECT:  Department of Defense Physical Disability Board of Review Recommendation for 
XXXXXXXXXXXXXXXXXX, AR20160018269 (PD201404199)

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