RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2015-00166
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20070723

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

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 - 20070615	VARD - 20070926	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Left Knee Patellar Tendonitis	5024	0%	Left Knee Patellar Tendonitis	5262	10%	20070719	
Adjustment Disorder…	Not a physical disability 	Adjustment Disorder	9400	NSC	STR	
COMBINED RATING:  0%	COMBINED RATING OF ALL VA CONDITIONS:  10%	

ANALYSIS SUMMARY:  

Left Knee Patellar Tendonitis.  According to service treatment records (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s left knee condition began in March 2005 after falling off a trailer and hitting his knee on a concrete floor.  Diagnostic imaging studies (X-ray) on 2 March 2005 showed a large spur of the anterior tibial tubercle with loose body assessed by the examiner as from developmental or previous fracture through the spur.  Diagnostic imaging (bone scan) studies on 24 March 2005 showed increased uptake at the tibial tubercle.  An open excision of patellar tendon enthesophyte (an abnormal bony projection into the tendon) surgery was performed on 10 May 2005.  Diagnostic imaging (X-ray) on 31 July 2006 showed no evidence of a significant bone abnormality.  There was soft tissue edema suggesting trauma of the patellar ligament.  Diagnostic imaging (MRI) studies on 25 August 2006 showed borderline effusion and degeneration of the menisci without evidence of a tear.  There were post-surgical changes as well.  Despite surgery and rehabilitation, the condition did not improve sufficiently to allow unrestricted duty.  The MEB forwarded “left knee patellar tendonitis,” for PEB adjudication.  

The MEB examinations dated 22 February 2007 (annotated on DD Form 2807 Report of Medical History and DD Form 2808 Report of Medical Examination) noted that the range of motion (ROM) of the knee was limited and painful.  The gait was abnormal due to pain and strength was reduced. During the MEB NARSUM examination dated 13 April 2007, 4 months prior to separation, the CI reported persistent left knee pain which prevented him from performing his military duties.  The pain was relieved by narcotic medications.  Physical examination showed no effusion or asymmetry.  Maneuvers for ligamentous instability and meniscus pathology were negative.  There was tenderness to palpation over the patellar tendon and tibial tuberosity.  The ROM was mildly limited in flexion (per VA standards although recorded as normal by the examiner), but normal in extension.  

At the 19 July 2007 VA Compensation and Pension (C&P) evaluation, performed 1 week before separation, the CI reported daily pain in his left knee with prolonged physical activity.  He experienced one event of instability weekly with associated numbness.  The pain was relieved by medication (Ibuprofen).  Physical examination showed an abnormal gait with limping on his left leg.  There was tenderness at the tibial plateau.  Examination tests for ligamentous instability and meniscus pathology were negative.  The ROM was limited in flexion by pain but normal in extension.  

The Board directed attention to its rating recommendation based on the above evidence.  The PEB rated the left knee condition 0%, coded 5024 (tenosynovitis), citing full ROM.  The VA rated the left knee condition 10%, coded 5262 (tibia and fibula, impairment of), citing painful motion based on the post-separation C&P examination.  There was no limitation of flexion or extension that supported a compensable 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), and there was no history of dislocated meniscus or loose body causing frequent locking with recurrent effusions (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 limited and painful motion with functional loss supporting a 10% rating (based on §4.59, §4.40 and §4.45) as found in the VA examination proximate to separation.  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 coded 5024.  

Contended PEB Conditions:  Adjustment Disorder with Disturbance of Emotions and Conduct.  The Board’s main charge is to assess the fairness of the PEB’s determination that the contended condition was not unfitting.  The contended condition was not profiled or implicated in the commander’s statement or judged to fail retention standards.  There was no performance-based evidence from the record that the condition significantly interfered with satisfactory duty performance at separation.  After due deliberation, the Board concluded that there was insufficient cause to recommend a change in the PEB fitness determination for the contended condition and so no additional disability rating is recommended.  

BOARD FINDINGS:  In the matter of the left knee patellar tendonitis condition, the Board unanimously recommends a disability rating of 10%, coded 5024 IAW VASRD §4.71a.  In the matter of the contended adjustment disorder with disturbance of emotions and conduct condition, the Board unanimously recommends no change from the PEB determination as not unfitting.  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	
Left Knee Patellar Tendonitis	5024	10%	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20150215, 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

SUBJECT:  Department of Defense Physical Disability Board of Review Recommendation for 
XXXXXXXXXXXXXXXXXX, AR20160016811 (PD201500166)

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