RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXXXX	CASE:  PD-2015-01018
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20050325

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was a National Guard E4, Indirect Fire Infantryman, medically separated for “right patellofemoral pain syndrome,” with a disability rating of 0%.

CI CONTENTION:  The CI made no specific contention.  His 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 - 20050301	No VA Rating Proximate to Separation 	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Right Patellofemoral Pain Syndrome	5099-5003	0%	N/A				
COMBINED RATING:  0%	COMBINED RATING OF ALL VA CONDITIONS:  N/A	

ANALYSIS SUMMARY:  

Right Patellofemoral Pain Syndrome.  According to service treatment records and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s right knee condition began in March 1997 while at airborne school.  In August 2004 the CI complained of right knee pain upon mobilization and subsequent impact training.  Diagnostic magnetic resonance imaging (MRI) in June 2004 and December 2004 showed evidence of degenerative change of the patellofemoral joint, but was otherwise negative for evidence of torn ligaments or torn menisci (cartilage).  Orthopedic evaluation, 26 October 2004, recorded a complaint of right knee pain with running, jumping, squatting and descending stairs.  There were no symptoms of locking or instability.  On examination, tests for stability were normal and tests for meniscus pathology were negative.  The range of motion was noted as “full.”  Patellofemoral pain syndrome of the right knee was diagnosed.  There was no surgical indication, and conservative treatment did not result in improvement sufficient to allow unrestricted duty. The MEB forwarded “right knee patellofemoral syndrome,” for PEB adjudication.  

During the orthopedic MEB examination dated 8 January 2005, 3 months prior to separation, the CI reported right knee pain which prevented him from performing the physical requirements for his job and military duties.  Physical examination showed normal strength, no crepitus, and examination tests for ligamentous instability and meniscus pathology were negative.  There was tenderness to palpation with pain of the patellofemoral tendon.  The range of motion was normal in flexion (135 degrees) and extension (0 degrees).  Radiographic (X-ray) studies were normal.  There was no VA Compensation and Pension examination proximate to the time of separation.  The first post-separation examination was in April 2010, 5 years after separation (flexion 120 degrees, extension 0 degrees).

The Board directed attention to its rating recommendation based on the above evidence.  The PEB rated the right knee condition 0%, coded 5099-5003 (arthritis, degenerative [hypertrophic or osteoarthritis]), citing the presence of pain.  Five years after separation, the VA rated the right knee condition 10%, coded 5014 (osteomalacia), citing painful or limited motion, however, the VA examination 5 years after separation was judged to be of limited probative value.  There was no limitation of flexion or extension that supported a 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) 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).  

However, there was evidence of painful motion with functional loss supporting a 10% rating (based on §4.59, §4.40 and §4.45). No additional functional limitation was evidenced by the examinations.  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 right patellofemoral pain syndrome condition, 5099-5003.

BOARD FINDINGS:  In the matter of the right patellofemoral pain syndrome condition, the Board unanimously recommends a disability rating of 10%, 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	
Right Patellofemoral Pain Syndrome	5099-5003	10%	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20150608, w/attachments
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 XXXXXXXXXXXXXXXXXXXXX, AR20170001054 (PD201501018)

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