RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2015-00792
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20080421

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 “right patellofemoral pain syndrome” and “left patellofemoral pain syndrome,” rated 10% and 10%, respectively, with a combined disability rating of 20%.

CI CONTENTION:  “Existing PTSD went undiagnosed.”  The CI’s complete submission is 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 - 20080306	VARD – N/A	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Right Patellofemoral Pain Syndrome	5099-5003	10%	No VA Claim in Record	
Right Patellofemoral Pain Syndrome	5099-5003	10%		
COMBINED RATING: 20%	COMBINED RATING OF ALL VA CONDITIONS:  N/A	

ANALYSIS SUMMARY:  

Bilateral Knee Pain.  According to service treatment record (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s bilateral knee condition developed in March 2005 without specific or direct injury.  Initial radiographic studies revealed osteochondral lesions (degenerative cartilage defect) of both knee caps in 2005 and follow-up studies in 2008 revealed the same on the left knee and normal on the right knee.  Despite conservative treatment, the bilateral knee condition could not be adequately rehabilitated to meet the physical requirements of the CI’s military specialty and the CI was referred for an MEB.  The MEB forwarded “bilateral patellofemoral pain syndrome (PFPS)” for PEB adjudication.
During the MEB examination dated 16 January 2008 (3 months prior to separation), the CI reported the inability to wear body armor, carry a combat load, run, jump, or climb.  His physical examination (PE) revealed full range of motion (ROM) of both knees with crepitus about the left knee cap.  There was no evidence of tenderness or instability. 

The case file did not contain a VA Compensation and Pension (C&P) examination and therefore, this Board’s final impairment rating will be based upon the STR and MEB-driven documents.  
 
The Board directed attention to its rating recommendation based on the above evidence.  The PEB rated each knee at 10% analogously coded under 5099-5003 (degenerative arthritis), citing painful motion.  There was no limitation of motion in either knee which supported a rating under the diagnostic codes for limitation of flexion or extension (5260, 5261).  The pre-separation examination did not demonstrate the presence of ligamentous instability or laxity (5257) in either knee, and there was no history of dislocated meniscus or loose body causing frequent locking with recurrent effusions in either knee (5258), or history of surgery to remove a meniscus (5259) in either knee to support a rating under the respective codes.   There was no fracture, non-union, or malunion of the femur or tibia of either knee to support consideration under the respective codes for knee impairment related to long bone conditions (5255, 5262).  There was therefore no VASRD §4.71a route to a rating higher than the 10% left knee and 10% right knee adjudicated by the PEB under any applicable code, and no grounds for additional rating for either knee 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’s adjudication for the bilateral knee condition.

BOARD FINDINGS:  In the matter of the bilateral knee condition and IAW VASRD §4.71a, the Board unanimously recommends no change in the PEB’s adjudication.  There were no other conditions within the Board’s scope of review for consideration.  The Board, therefore, recommends that there be no modification or re-characterization of the CI’s disability and separation determination.

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20150530, 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, AR20170000788 (PD201500792)

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