RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2017-00320
BRANCH OF SERVICE:  Army	SEPARATION DATE:  20091118

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects this covered individual (CI) was a National Guard E4, Trainee, medically separated for “patellofemoral pain syndrome [right knee]” with a disability rating of 10%.  

CI CONTENTION:  Review requested of knee condition and additional conditions not identified by the Medical Evaluation Board (MEB) and Physical Evaluation Board (PEB).  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 - 20091023	VARD - 20100105	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Patellofemoral Pain Syndrome, Right Knee	5099-5003	10%	Right Knee Sprain	5099-5020	0%	20091222	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  10%	

ANALYSIS SUMMARY:  

Right Knee Patellofemoral Pain Syndrome.  According to the service treatment record and MEB narrative summary (NARSUM), the CI’s right knee pain began in April 2009 after an injury during pugil stick training.  She was placed on a temporary profile, given pain medication, and attended physical therapy for 6 months with no improvement.  Right knee X-rays showed soft tissue swelling with a small effusion and an MRI showed myxoid degeneration due to lack of visualization of the tear extending into the articular surface, but was otherwise normal.  
The 2 September 2009 MEB NARSUM examination, 2 months prior to separation, noted CI complaints of constant right knee pain rated at 2/10 and increased to 6/10 with weight bearing activities such as climbing, descending stairs, carrying weights, or running.  Physical examination showed a normal gait and no swelling or effusion.  There was positive tenderness along the patellofemoral area to include the medial patella facet and patella tendon.  Goniometrically measured range of motion (ROM) was painful, with flexion to 130 degrees (normal 140) and extension to 0 degrees.  A patella grind test was negative with no joint line tenderness, and Lachman’s, McMurray’s, valgus and varus stability tests were normal.   Muscle strength was 5/5 and equal bilaterally.  

At the 22 December 2009 VA Compensation and Pension (C&P) examination, 1 month after separation, the CI reported right knee pain and the ability to stand for up to 3 hours and walk 1-3 miles.  Physical examination revealed no objective evidence of instability or abnormal weight bearing.  Measure ROM was pain-free with flexion to 123 degrees and extension to 0 degrees.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the right knee condition 0%, analogously coded 5099-5003 (arthritis, degenerative), citing painful motion.  The VA rated the right knee condition 0%, analogously coded 5099-5020 (synovitis), based on the C&P examination, citing absence of objective evidence of painful or limited motion of a major joint or group of minor joints.  Members agreed 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).  There was no history or evidence 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 that those codes.  There was no fracture, nonunion 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 therefore no VASRD §4.71a rating higher than the 10% adjudicated by the PEB under any applicable code.  After due deliberation, considering all the evidence and mindful of VASRD §4.3 (reasonable doubt), the panel concluded 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 patellofemoral pain syndrome and IAW VASRD §4.71a, the panel 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 20170206, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Record 

AR20180014532, 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.