RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXX	CASE:  PD-2015-02554
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20050125

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E4, Tank Crewman, medically separated for “right knee pain” with a disability rating of 0%.

CI CONTENTION:  “Review all conditions.”  The complete submission is at Exhibit A.  

SCOPE OF REVIEW:  The panel’s scope of review is defined in DoDI 6040.44.  It is limited to review of disability ratings assigned 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 or non-compensable.  Any conditions outside the panel’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 panel’s authority is limited to assessing the fairness and accuracy of PEB rating determinations and recommending corrections, where appropriate.  The panel’s assessment of the PEB rating determination 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(s) at the time of separation.  The panel 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 panel 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 - 20041004	VARD - 20050616	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Right Knee Pain	5024	0%	Chronic Patellar Tendonitis, Right Knee	5099-5024	0%	20050228	
Pes Planus	Not Unfitting	Pes Planus	5276	NSC	STR	
Correctable Vision	Not Unfitting	No VA Placement	
COMBINED RATING:  0%	COMBINED RATING OF ALL VA CONDITIONS:  0%	

ANALYSIS SUMMARY:  

Right Knee.  According to the service treatment record (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s right knee pain condition began in May 2002 after jumping off of a tank.  Knee X-rays were negative.  The CI reported pain of the anterior knee, located below the patella, aggravated by activity, with swelling at times.  He was diagnosed with a partial tear of the patellar tendon which led to chronic patellar tendonitis.  Examinations in the STR noted full knee range of motion (ROM) with tenderness to palpation (TTP) of the patellar insertion on the tibia and at times painful ROM and mild swelling.  The CI was placed on a permanent L2 profile in February 2004.  The CI was evaluated by orthopedics for an MOS Medical Review Board in August 2004 and a permanent L3 profile.  
At the MEB Orthopedic consult on 31 August 2004 (also the review for MMRB), 5 months prior to separation, the CI reported intermittent swelling with activity and inability to do his job despite a permanent L2 profile.  On examination the CI was noted to have TTP of the insertion of the patellar tendon on the tibia.  There was no effusion or joint line tenderness and diagnostic tests for knee instability and meniscal pathology were negative.  

During the 31 August 2004 MEB examination (recorded on DD Forms 2807 and 2808), 5 months prior to separation, the CI reported chronic retropatellar pain syndrome.  Physical examination showed normal ROM as indicated in the chart above.  The CI did have a positive patellar grind test, but there was no TTP, laxity, or effusion.  

At the 23 September 2004 MEB NARSUM, 4 months prior to separation, the CI reported intermittent right knee pain.  The MEB NARSUM examination was performed by the same examiner who performed the DD Form 2808 exam and cited the same examination findings summarized above.  

At the 28 February 2005 VA Compensation and Pension (C&P) evaluation, performed 1 month after separation, the CI reported daily right knee pain, graded 5/10, with occasional stiffness and swelling, and pain with prolonged sitting, but no instability, giving way, “locking” or recurrent dislocation or subluxation.  Physical examination showed a normal gait.  There was anterior patellar TTP without swelling or effusion.  There was normal ROM with no pain on motion and knee motion was not additionally limited by pain, fatigue, weakness, or lack of endurance following repetitive use.  There was no weakness, abnormal movement or guarding of movement and no evidence of instability or meniscal pathology. 

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the right knee condition 0%, coded 5024 (tenosynovitis), citing “tenosynovitis without loss of joint motion.”  The VA rated the right knee condition 0%, coded 5099-5024 (analogous to tenosynovitis), citing “continued disability to the knee and pain on palpation” without painful or limited motion.  

Although the CI had a long history of right knee pain and swelling prior to separation, his symptoms were improving while on the permanent L2 profile and at the VA examination one month after separation exam of the knee was completely normal, consistent with improvement with sustained activity modification as would be expected when the CI was separated from the rigors of the military lifestyle.  There was therefore insufficient evidence of painful motion with functional loss supporting a 10% rating (based on §4.59, §4.40 and §4.45) proximate to separation.  There was likewise was no limitation of motion which attained a minimum rating under the diagnostic codes for limitation of flexion or extension (5260, 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).  No additional functional limitation was evidenced by the examinations.  Therefore the panel concluded there was not sufficient evidence to support a rating higher than the 0% adjudicated by the PEB.  

Contended PEB Conditions:  Pes Planus and Correctable Vision.  The panel’s main charge is to assess the fairness of the PEB’s determination that the contended conditions were not unfitting.  The pes planus condition was not profiled.  The correctable vision was given a permanent E2 profile for vision requiring glasses.  Neither of these conditions were implicated in the commander’s statement or judged to fail retention standards.  
There was no performance-based evidence from the record that either of the conditions significantly interfered with satisfactory duty performance at separation.  After due deliberation, the panel concluded that there was insufficient cause to recommend a change in the PEB fitness determination for either of the contended conditions and so no additional disability ratings are recommended.  

BOARD FINDINGS:  In the matter of the right knee condition and IAW VASRD §4.71a, the panel unanimously recommends no change in the PEB adjudication.  There are no other conditions within the panel’s scope of review for consideration.  

The panel, 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 20151105, with attachments
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

AR20170013318, XXXXXXXXXXXXXXXXXXX

XXXXXXXXXXXXXXXXXXX

Dear XXXXXXXXXXXXXXXXXXX:

	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