RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2015-01917
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20030731

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E3, Infantryman, medically separated for “retropatellar pain syndrome, right knee” with a disability rating of 10%.

CI CONTENTION:  The CI contends he should have been medically retired.  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 - 20030611	VARD - 20031008	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Retropatellar Pain Syndrome, Right Knee	5099-5003	10%	Retropatellar Pain Syndrome, Right Knee	5299-5260	10%	STR	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  10%	

ANALYSIS SUMMARY:  

Retropatellar Pain Syndrome, Right Knee.  According to service treatment records (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s right knee pain began in October 2002 when he twisted his leg during a road march.  There was no surgical indication, and conservative treatment did not result in improvement sufficient to allow unrestricted duty.  Knee X-rays and magnetic resonance imaging (MRI) studies in November 2002 were normal.  The MEB forwarded retropatellar pain syndrome for PEB adjudication.  

At the MEB examination (recorded on DD Forms 2807 and 2808) dated May 2003, 2 months prior to separation, the CI reported a dislocated patella.  Physical examination showed edema, tenderness and decreased range of motion (ROM) and there was no mention of a dislocated patella on examination.  

The MEB NARSUM examination on 9 May 2003, 2 months prior to separation, noted complaints of inability to run, jump, march, carry a ruck, or lift up to 15 pounds without pain.  Physical examination showed “some tenderness” and mild edema bilaterally to the knees with “decreased range of motion” of the right knee.  The examiner further noted the condition was stable with the chronic knee pain rated as “moderate constant.”  There was no VA Compensation and Pension (C&P) evaluation addressing the knee condition in evidence.  

The Board directed attention to its rating recommendation based on the above evidence. The PEB rated the right knee pain10%, coded 5003 (Arthritis, degenerative (hypertrophic or osteoarthritis)), citing the US Army Physical Disability Agency (USAPDA) pain policy.  The VA also rated the right knee pain 10% coded 5260 (Leg, limitation of flexion of), based on the STR, 3 months after separation citing “motion noted in March 2003 was limited to 0 to 100 degrees.” 

There was no limitation of motion which supported a rating under the diagnostic codes for limitation of flexion or extension (5260, 5261).  However, there was evidence of painful motion with functional loss supporting a 10% rating (based on §4.59, §4.40 and §4.45) as adjudicated by the PEB. 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).  There was no VASRD §4.71a 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 pain.  

BOARD FINDINGS:  In the matter of the right knee pain and IAW VASRD §4.71a, the Board 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 20150708, with attachments
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

AR20170007979, XXXXXXXXXXXXXXXXXX 

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Dear XXXXXXXXXXXXXXXXXX:

	The Department of Defense Physical Disability Board of Review (DoD PDBR) reviewed your application and found your separation disability rating and your separation from the Army for disability with severance pay to be accurate.  I have reviewed the Board’s recommendation and record of proceedings (copy enclosed), and I accept its recommendation.  I regret to inform you that your application to the DoD PDBR is denied.  

	This decision is final.  Recourse within the Department of Defense or the Department of the Army is exhausted; however, you have the option to seek relief by filing suit in a court of appropriate jurisdiction.

Sincerely,					       
						      					
Enclosure