RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2016-01559
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20070810

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E5, Financial Management Technician, medically separated for “right knee patellar subluxation” with a disability rating of 10%.  

CI CONTENTION:  “The VA rating was changed.”  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 Medical Evaluation Board (MEB), but determined by the PEB 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.  The panel’s authority is limited to assessing the fairness and accuracy of PEB rating determinations and recommending corrections when appropriate.  The panel’s assessment of the PEB rating determination is based on review of medical records and all available evidence relevant to application of the Veterans Affairs Schedule for Rating Disabilities (VASRD) standards for 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, which operates 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 disability at the time of separation.  

RATING COMPARISON:  

SERVICE PEB - 20060620	VARD - 20070122	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Right Knee Patellar Subluxation	5299-5257	10%	Residuals, Lateral Release, Right Knee	5261	10%	20060801	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  60%	

ANALYSIS SUMMARY:  

Right Knee Patellar Subluxation.  According to the service treatment record (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI underwent an arthroscopic lateral release of the patella in March 2006.  The 5 June 2006 MEB NARSUM examination, 2 months prior to separation, noted complaints of pain despite rest and physical therapy.  The focused physical examination showed trace effusion (fluid collection) bilaterally.  There was significant tightness of the lateral retinaculum, patella lateral tilting, patella passive subluxation, tenderness over healed portal, and 3+ patellar apprehension (apprehension or pain on quadriceps contraction with patella displaced).  The Q angle (angle between the quadriceps muscles and the patella tendon) was increased.  The McMurray (assesses menisci), drawer (assesses ACL and posterior cruciate ligament [PCL]), Lachman (assesses ACL), and pivot shift (assesses ACL) tests were negative.  There was patellar entrapment bilaterally, however, no crepitus (grating sensation or sound).  Range of motion (ROM) measurements showed a flexion of 125 degrees (normal 140), with pain past 95 degrees, and normal extension of 0 degrees.  

At the 1 August 2006 VA Compensation and Pension (C&P) evaluation, at separation, the CI reported difficulty navigating stairs, walking and running long distances, or standing stationary for extended lengths of time.  Knee support was worn during vigorous physical activities.  Physical examination showed a normal gait.  The right knee examination revealed superficial, stable, non-tender, non-adherent scars with anterior patellar tendon tenderness.  Pain-limited ROM measurements showed a flexion of 130 degrees and a normal extension of 0 degrees.  There was no swelling, effusion, or ligament instability noted.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the right knee condition 10%, analogously coded 5299-5257 (knee, other impairment of), citing persistent pain status post lateral release rated as slight.  The VA rated the right knee condition 10%, coded 5261, (leg, limitation of extension), citing painful motion of a major joint.  There was no evidence of moderate subluxation or lateral instability to support a 20% rating under the 5257 code (knee, other impairment of).  There was no femur impairment (5255), knee ankylosis (5256), dislocated meniscus or loose body causing frequent locking with recurrent effusions (5258), surgery to remove a meniscus (5259), limitation of motion (5260, 5261), fracture, non-union, or malunion of the tibia or fibula (5262), or genu recurvatum (5263) for consideration under the respective codes.  No additional functional limitation was evidenced by the examinations.  After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the panel 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 patellar subluxation 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.  Therefore, the panel recommends 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 20161012, w/attachments
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

AR20180004015, XXXXXXXXXXXXXXXXXX 

XXXXXXXXXXXXXXXXXX

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.

A copy of this decision has been provided to the counsel you listed on your application, XXXXXXXXXXXXXXXXXX.

Sincerely,					      
Enclosure