RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXX	CASE:  PD-2016-00130
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20070516

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E2, Basic Trainee, medically separated for “chronic pain, right knee,” with a disability rating of 0%.

CI CONTENTION:  The CI contends the rating should have been higher and that the condition continues to worsen.  The CI’s 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 - 20070418	VARD - 20071108	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Pain, Right Knee	5099-5003	0%	Right Patellofemoral Syndrome	5299-5257	0%	20070716	
COMBINED RATING:  0%	COMBINED RATING OF ALL VA CONDITIONS:  0%	

ANALYSIS SUMMARY:  

Right Knee Pain.  According to the service treatment record (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI experienced an onset of knee pain with running in May 2006 (basic training, 12 months before separation).  She was diagnosed with a subluxing patella that was treated successfully with a brace.  Magnetic resonance imaging (MRI) was normal and specified that all four ligaments and the menisci were intact.  There was ample documentation in STR clinical entries of the absence of persistent effusion or signs of impingement (locking), and of joint stability to stress testing.  There was ample documentation of range of motion (ROM) with flexion in the range of 125-130 degrees (normal 140, 45 for minimum 10%) and 0 degrees extension (normal).  Multiple entries confirmed the presence of painful motion, and there was intermittent note of an antalgic gait.

The 4 April 2007 NARSUM examination, 6 weeks prior to separation, documented “chronic daily” pain that limited prolonged standing, “brisk” walking, and negotiating stairs.  The physical examination recorded tenderness, the absence of effusion or impingement, and 4-plane stability to stress testing.  The NARSUM cited goniometric ROM measurements by physical therapy conducted a month earlier (3 March 2007).  These were flexion to 125 degrees and 0 degrees extension, specifying painful motion.

A 16 July 2007 VA Compensation and Pension (C&P) examination, 2 months after separation, documented chronic pain rated 3/10 at baseline, with exacerbations to 6-7/10 by prolonged standing or walking and negotiating stairs.  The physical examination recorded “a mild limp” and the absence of swelling, without comment regarding joint stability or impingement.  Measured ROM was normal for flexion and extension, and specified pain at end range without degradation on repetition.

The panel directed attention to its rating recommendation based on the above evidence.  The PEB’s 0% rating under code 5099-5003 (analogous to degenerative arthritis) cited the “slight/intermittent” criterion of the US Army Physical Disability Agency (USPDA) pain policy.  The VA‘s 0% rating under code 5299-5257 (analogous to ‘knee, other impairment’ that rates for recurrent subluxation or instability) was based on the C&P evidence and cited failure to meet the minimum 10% criterion of “slight” disability.  Code 5257 is of dubious applicability to this case, but offers additional ratings of 20% for “moderate” and 30% for “severe” disability.

The PEB’s 0% rating under criteria of code 5003 was supported by the USPDA pain policy, but members agreed that there was ample evidence of painful motion to support a minimum 10% rating IAW VASRD §4.59.  There was no ROM limitation, persistent effusion and locking, or fracture with non-union or malunion to achieve a rating higher than 10% under any applicable code; and, there was no objective evidence of joint instability (corroborated by the MRI findings) for separate or higher rating under code 5257.  

After due deliberation, considering all of the evidence and conceding VASRD §4.3 (reasonable doubt), the panel recommends a 10% rating for the right knee condition under code 5024 (tenosynovitis, defaulting to criteria of 5003).

BOARD FINDINGS:  In the matter of the right knee condition, the panel unanimously recommends a disability rating of 10%, coded 5024 IAW VASRD §4.71a.  There are no other conditions within the panel’s scope of review for consideration.

The panel recommends that the CI’s prior determination be modified as follows, effective as of the date of his prior medical separation:  

CONDITION	VASRD CODE	PERMANENT RATING	
Patellofemoral Syndrome, Right Knee	5024	10%	
COMBINED	10%	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20160311, with attachments
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

AR20170014064, XXXXXXXXXXXXXXXXXXX

XXXXXXXXXXXXXXXXXXX

Dear XXXXXXXXXXXXXXXXXXX:

	The Department of Defense Physical Disability Board of Review (DoD PDBR) reviewed your application and found that your disability rating should be modified but not to the degree that would justify changing your separation for disability with severance pay to a permanent retirement with disability.  I have reviewed the Board’s recommendation and record of proceedings (copy enclosed) and I accept its recommendation.  This will not result in any change to your separation document or the amount of severance pay.  A copy of this decision will be filed with your Physical Evaluation Board records.  I regret that the facts of the case did not provide you with the outcome you may have desired.
  
	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. 

	A copy of this decision has also been provided to the Department of Veterans Affairs.

Sincerely,	
Enclosure