RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2015-00359
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20050528

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E4, Military Policeman, medically separated for “left knee patellofemoral pain syndrome [PFPS]” with a disability rating of 0%.  

CI CONTENTION: The CI contends for his unfitting knee condition and his not unfitting hypertension as well as a number of conditions not identified by either the MEB or PEB.  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 - 20050310	VARD - 20100216	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Left Knee PFPS	5099-5003	0%	Chronic Left Knee Strain	5024	10%	20100123	
Hypertension	Not Unfitting	Hypertension	7101	0%	20100123	
COMBINED RATING:  0%	COMBINED RATING OF ALL VA CONDITIONS:  60%	

ANALYSIS SUMMARY:  

Left Knee PFPS.  According to service treatment records (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI suffered a twisting injury to his left knee when he fell during a run in October 2003.  Pain persisted and magnetic resonance imaging revealed chondromalacia patella (damage to the cartilage under the knee cap), but reported intact ligaments and menisci.  Outpatient STR entries documented grossly normal or marginally limited range of motion (ROM), some noting painful motion, and no entries indicated any significant ROM limitation.  There was ample STR documentation of the absence of effusion, stability to stress testing, and negative signs of impingement; and, there were no entries to the contrary. Surgery was not indicated; conservative treatment did not result in sufficient improvement to allow unrestricted duty; and, the CI was referred for MEB.  The MEB forwarded “left knee patellofemoral pain syndrome/chondromalacia” to the PEB.  

The NARSUM examination on 30 December 2004, 5 months before separation, documented persistent pain that limited load bearing, standing (10-15 minutes), and running (1/4 mile).  The physical examination noted “walks with a limp,” anterior tenderness, stability to stress testing, and negative signs of impingement.  The recorded ROM was flexion to 110 degrees (normal 140, minimum compensable 45) and extension minus 5 degrees (normal 0, minimum compensable minus 10).  Measured ROM for the MEB by physical therapy a few days after the NARSUM was flexion to 100 degrees and extension minus 20 degrees, noting painful motion and guarding.  This significant limitation of extension was in marked contrast to all other evidence, clinically incongruent with the pathology, and thus suffered greatly in probative value.  The earliest VA Compensation and Pension (C&P) examination was in January 2010, over four years after separation; and, was thus of marginal probative value.  It documented persistent pain, antalgic gait, the absence of instability or impingement, and measured ROM of flexion to 110 degrees and extension 0 degrees (specifying painful motion).  

The Board directed attention to its rating recommendation based on the above evidence.  The PEB’s 0% rating analogous to 5003 (degenerative arthritis) cited the involvement of only one joint.  The VA’s 10% rating (based on the temporally remote C&P evidence) was under code 5024 (tenosynovitis) and cited painful motion.  Although there was no minimum compensable ROM limitation, the PEB’s 0% rating did not account for VASRD §4.59 (painful motion) or §4.40 (functional loss).  There was amply documented painful motion and the gait disturbance was adequate demonstration of functional loss.  Members thus agreed that §4.59 and/or §4.40 were reasonably conceded in support of the minimum compensable rating 10% rating.  There was no persistent effusion and locking, or fracture with non-union or malunion, to achieve a rating higher than 10% under any alternate code; and, there was no evidence of joint instability for separate rating.  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; proposing code 5024 for its clinical compatibility.  

Contended Hypertension.  The Board’s main charge was to assess the fairness of the PEB’s determination that hypertension was not unfitting.  The hypertension was stable, asymptomatic, and controlled on medication.  It was not profiled, implicated in the commander’s statement, or judged to fail retention standards.  Members agreed that there was no performance-based evidence that the condition significantly interfered with satisfactory duty performance at separation.  After due deliberation 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 condition; thus, it was not eligible for disability rating.  

BOARD FINDINGS:  In the matter of the left knee condition, the Board unanimously recommends a Service disability rating of 10%, coded 5024 IAW VASRD §4.71a.  In the matter of the contended hypertension 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	
Patellofemoral Pain Syndrome, Left Knee	5024	10%	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20150527, 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

21 DEC 2016

SUBJECT:  Department of Defense Physical Disability Board of Review Recommendation for 
XXXXXXXXXXXXXXXXXX, AR20160018696 (PD201500359)

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