RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2015-01240
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20080709

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E4, Petroleum Supply Specialist, medically separated for “right knee patellofemoral pain syndrome…,” with a disability rating of 10%.  

CI CONTENTION:  The CI contends his knee condition continues to worsen and negatively impact his daily activities.  The CI also contends for his 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 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 - 20080516	VARD 	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Right Knee PFS…	5099-5003	10%	No VA Examination in Evidence	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  NA	

ANALYSIS SUMMARY:  

Right Knee Patellofemoral Pain Syndrome.  According to service treatment records and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI initially injured his right knee in 2005 and continued to have pain despite conservative management.  He reinjured it in July 2007 and was referred for a magnetic resonance image which showed a torn anterior collateral ligament (ACL) as well as a medial meniscus tear (MMT, a tear of an internal cartilage cushion).  These were repaired surgically in early November 2007.  He was referred for rehabilitation following surgery, but compliance was sub-optimal.  At the time of the orthopedic clinic appointment on 6 February 2008, 3 months after surgery and 5 months before separation, the CI reported ongoing pain.  On examination, an effusion and quadriceps atrophy were present; the range of motion (ROM) was reduced.  At the time of the physical therapy (PT) clinic appointment on 12 March 2008, 4 months before separation, the CI reported continued pain and giving out with intermittent swelling.  The examiner recorded that the CI failed to attend therapy sessions and did not schedule appointments for postop physical therapy.  On examination, the right knee flexion, following repetitive movement, was 110 degrees (normal 140) and extension was “full”.  There was mild to moderate effusion.  Right quadriceps atrophy was noted.  There was tenderness.  The knee was stable.  In orthopedics a week later, the CI had painful flexion reduced to 120 degrees and a stable knee without signs of meniscal irritation.  He was diagnosed with patello-femoral syndrome (PFS) and referred for an MEB.  The MEB NARSUM, dated 19 March 2008, 4 months prior to separation, noted that the CI complained of increasing pain and giving way of his right knee.  On examination, the right knee ROM was limited to 120 degrees of flexion which was the onset of pain.  There was tenderness and significant quadriceps atrophy; however, his strength remained normal.  The surgical scars were well healed and the neurological examination was normal.  The knee stable.  He was thought to have PFS, status post ACL repair.  At the PT appointment on 29 April 2008, 2 months before separation, the right knee ROM following repetitive movement was flexion 110 degrees (normal 140) and extension 0 degrees (normal 0).  The knee was stable.  Weakness of the quadriceps was noted.  

There was no VA Compensation and Pension (C&P) examination in evidence.  

The Board directed attention to its rating recommendation based on the above evidence.  The PEB rated the right knee condition 10%, coded 5099-5003 (degenerative arthritis), citing painful motion.  There is not a VA rating in evidence.  The limitation of motion is not compensable and the knee was stable.  While there is evidence that there was an MMT, there is no history of locking following surgery to support a higher rating.  (It was noted on the MEB 2807, but this documents any history, not just current symptoms).  The Board found no route to a rating higher than the 10% adjudicated by the PEB under any applicable code and no grounds for additional rating 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 adjudication for the right knee condition.  

BOARD FINDINGS:  In the matter of the right knee 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 20150610, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

SAMR-RB						

MEMORANDUM FOR Commander

08 MAR 2017

SUBJECT:  Department of Defense Physical Disability Board of Review Recommendation for 
XXXXXXXXXXXXXXXXXX, AR20170002454 (PD201501240)

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