RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2015-01070
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20050711

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E4, Patriot System Repairer, medically separated for “chronic right knee pain secondary to patellofemoral 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 - 20050526	VARD – 20100722  (5 years post-separation)	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Right Knee Pain Secondary to PFS	5099-5003	0%	Right Knee PFS	5257	0%	20100621	
COMBINED RATING:  0%	COMBINED RATING OF ALL VA CONDITIONS:  0%	

ANALYSIS SUMMARY:  

Chronic Right Knee Pain Secondary to Patellofemoral Syndrome (PFS).  According to service treatment records and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the first records in evidence for the right knee pain condition were in August 2004 when the CI was treated in physical therapy (PT) for atraumatic knee pain which was aggravated by running.  There was no surgical indication, and conservative treatment (medications, PT, and duty restrictions) did not result in improvement sufficient to allow unrestricted duty.  In orthopedics on 9 November 2004, he was noted to have pain with squatting and weight-bearing.  On examination, the range of motion (ROM) was full and pain-free although right knee had less flexion than the left due to tightness.  The knee was stable.  A patellar grind (compression of the kneecap) was negative.  He was thought to have a plica (redundant soft tissue inside the knee) which improved with an injection.  The MEB forwarded “right knee patellofemoral syndrome” for PEB adjudication.  

The 31 March 2005 MEB examination (recorded on DD Forms 2807 and 2808), 3 months prior to separation was unremarkable.  During the 19 April 2005 MEB NARSUM examination, the examiner noted complaints of “unbearable pain” with running, standing, sitting, crossing legs, wearing equipment or ruck marching.  The physical examination showed near full range of motion (ROM) of 0-130 (140 normal) degrees flexion without ligamentous laxity or effusion.  The right knee was stable in all planes.  The gait was normal and the neurological examination was intact.  The CI did have pain with deep palpation to the patella (kneecap).  X-rays of the right knee were normal.  Atrophy was not recorded.  The VA Compensation and Pension (C&P) evaluation, performed on 24 June 2010, 5 years after separation, was too remote for probative value at separation.  

The Board directed attention to its rating recommendation based on the above evidence.  The PEB rated the right knee pain 0%, analogously coded 5003 (arthritis, degenerative (hypertrophic or osteoarthritis)), citing “no loss of joint motion or evidence of instability.  Rated for pain, slight/intermittent.”  The VA rating decision dated 22 July 2010, 5 years after separation, was remote from separation.  There was no limitation of flexion or extension, ligamentous instability or laxity, or history of dislocated meniscus or loose body causing frequent locking with recurrent effusions to support a compensable rating under those respective codes.  The gait was normal and atrophy was not recorded.  Pain with activity was noted, but pain with motion was recorded as absent.  The Board considered a 10% rating based on VASRD §4.59, §4.40 and §4.45 (painful motion, functional loss, and the joints), but the evidence was not sufficient to support this rating. 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 adjudication for the right knee pain condition.  

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

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20150530, with 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

08 MAR 2017

SUBJECT:  Department of Defense Physical Disability Board of Review Recommendation for 
XXXXXXXXXXXXXXXXXX, AR20170001109 (PD201501070)

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