RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2015-00085
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20040514

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an National Guard E3, Unit Supply Specialist, medically separated for “patellofemoral pain syndrome left knee,” with a disability rating of 0%.

CI CONTENTION:  The CI asserts her knee condition impacts her ability to perform daily activities including maintain employment.  She further contends this condition is causing other medical problems.  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 on 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 - 20040402	VARD – 20040816 	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Patellofemoral Pain Syndrome Left Knee…	5099-5003	0%	Patellofemoral Pain Syndrome with Initital Effusion; Left Knee	5099-5024	NSC	None	
COMBINED RATING:  0%	COMBINED RATING OF ALL VA CONDITIONS:  N/A	

ANALYSIS SUMMARY:  

Patellofemoral Pain Syndrome Left Knee.  According to service treatment records (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s left knee condition began in September 2002 during a run for physical training during Advance Individual Training.  The CI reported swelling and pain of the left knee.  Radiographic studies showed normal bilateral knees.  An orthopedic evaluation on 23 January 2003 showed full range of motion (ROM) of the left knee.  There was atrophy of the quadriceps muscle.  There was a positive patellar grind and patellar crepitus with ROM.  The CI was able to hyperextend the knee by 10 degrees, but testing for anterior-posterior instability was negative.  There was some lateral instability noted with varus stress.  There was no evidence of meniscal injury.  The diagnosis was patellofemoral syndrome.  The CI was treated with medications, rest and physical therapy, but any effort to return to normal physical activities aggravated the knee pain and swelling.  The CI was diagnosed with patellofemoral syndrome and patellar instability by orthopedics.  She was given a brace to wear and a MEB was initiated.  The MEB forwarded “patellofemoral pain syndrome” for PEB adjudication.  

During the MEB examination (recorded on DD Forms 2807 and 2808) dated 1 December 2003, 5 months prior to separation, the CI reported numbness, swelling, and tingling in her knee.  The CI reported she wore a knee brace.  Physical examination showed tenderness to palpation of the left knee, and a positive patellar apprehension test.  There was no evidence of instability or laxity, but there was pain with instability testing noted.  There was no effusion or swelling and the CI was able to heel toe and duck walk with some knee pain.  The examiner also noted that the CI wore a knee brace.  At the MEB NARSUM examination, 9 December 2003, the CI reported that her left knee pain occurs “a lot of the time.”  The pain varies from 3/10 to 10/10 with prolonged walking, standing, sitting, bending her knee or driving.  Her knee gives out while she is waking on occasion.  The physical examination was the same as recorded on DD Form 2808, as stated above.  

The Board directed attention to its rating recommendation based on the above evidence.  The PEB rated the left knee condition 0%, coded 5099-5003 (arthritis, degenerative), citing no joint laxity, no focal neurovascular deficits, full range of motion, no medication, and no note of sleep disturbance.  The VA denied service connection for the left knee patellofemoral syndrome citing unavailability of service medical records, failure of the CI to report to VA examination, and no evidence of chronic left knee disability incurred or aggravated by active duty service.  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).  There was no history of dislocated meniscus or loose body causing frequent locking with recurrent effusions (5258), or history of surgery to remove a meniscus (5259) 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).  There was evidence of patellar instability that was improved somewhat with physical therapy for quadriceps muscle strengthening.  Pain with ligamentous stress was documented at the MEB exams and the CI continued to wear a patellar stabilizing brace.  The Board concluded this was also sufficient for a 10% rating alternatively coded as 5257 (knee impairment due to recurrent subluxation or lateral instability).  In this case the Board consensus was that a dual rating was not warranted for the knee since at separation there was no evidence of persistent significant laxity, but there was pain with ligamentous stress.  There was full ROM of the knee and X-rays did not show degenerative changes and as noted, there was no evidence of meniscal pathology to support a separate rating.  The Board consensus was that the knee could be rated 10% analogous to 5003 or alternatively under 5257.  Therefore, the Board determined there was no VASRD §4.71a route to a rating higher 10% under any applicable code and there was insufficient grounds for ratings for both limitation of motion and instability.  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 patellofemoral pain syndrome left knee condition, the Board unanimously recommends a disability rating of 10%, analogously 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 the prior medical separation:  

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

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20150613, 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

03 MAR 2017

SUBJECT:  Department of Defense Physical Disability Board of Review Recommendation for 
XXXXXXXXXXXXXXXXXX, AR20170002966 (PD201500085)

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