RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX 	CASE:  PD-2017-00529
BRANCH OF SERVICE:  ARMY 	SEPARATION DATE:  20071108

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 “chronic right patellofemoral pain syndrome” with a disability rating of 0%.  

CI CONTENTION:  His condition has worsened.  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 - 20070921	VARD - 20080227	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Right Patellofemoral Pain Syndrome	5009-5003	0%	Patellofemoral Syndrome, Right Knee	5257	10%	20080118	
COMBINED RATING:  0%	COMBINED RATING OF ALL VA CONDITIONS:  10%	

ANALYSIS SUMMARY:  

Chronic Right Patellofemoral Pain Syndrome.  According to the service treatment record and MEB narrative summary (NARSUM), the CI’s right knee condition began in September 2006 while deployed to Afghanistan when an artillery round fell short causing an object to strike him in his right knee.  He continued his mission and sought treatment upon return to the forward operating base.  Upon re-deployment he was evaluated during Soldier Re-integration Processing (SRP) and was referred to orthopedics.  At the 2 April 2007 orthopedic examination the CI reported stabbing and right knee pain which increased with prolonged sitting, stairs, squatting, and running.  The pain was controlled by medication.  Physical examination showed a positive patella grind and crepitus with motion.  Range of motion (ROM) was noted as full and painless. There was right quadriceps atrophy.  Radiographic studies (X-rays and MRI) were normal.  He was treated with physical therapy (PT) without relief and was placed on a permanent L3 profile.  

At the time of the orthopedics clinic appointment on 10 July 2007, 4 months prior to separation, the examiner noted crepitus and full ROM.  There was a positive patella femoral grinding test without effusion, swelling, erythema, or deformity.  There was no increased medial, lateral, or multi-directional mobility, no tenderness at the joint line, and no laxity of the medial collateral ligament, lateral collateral ligament, anterior cruciate ligament, or posterior cruciate ligament.  At the 3 August 2007 PT clinic appointment, the right knee ROM measured at 131 flexion (140 normal) and 0 extension (0 normal).  The therapist noted that motion was not limited by pain.  

At the 24 August 2007 MEB NARSUM examination, 3 months prior to separation, the examiner noted that the CI’s right knee was mildly tender.  There was no swelling, erythema, or effusion.  He noted full ROM and referenced the PT ROM measurements.  The examiner also noted the 8 May 2007 MRI of the right knee as essentially normal.  

At the 18 January 2008 Compensation and Pension (C&P) evaluation, 2 months after separation, the CI reported constant pain rated at 5-6/10, increased to  7-8/10 if he were to walk upstairs or perform any walking on an elliptical machine for greater than 20 minutes, walk greater than 2 miles, or cold/damp weather.  He did not report any locking and stated his condition did not significantly affect his work or activities of daily living.  He reported that repetitive motion would increase his pain and that he was unable to participate in any type of rigorous sporting activities.  Physical examination showed mild joint effusion and tenderness over the pre-patellar area.  There was marked crepitus to palpation and negative drift, Lachman’s test, and McMurray’s test.  ROM was 140 degrees flexion with mild pain.  There was no additional limitation of motion with repetition.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the right knee condition 0%, coded analogously 5099-5003 (degenerative arthritis), citing the U.S. Army Physical Disability Agency Policy/Guidance Memorandum #12, dated February 2005, Subject: Table of Analogous Codes.  The VA also rated the right knee condition 10%, coded 5257 (knee, other impairment of), citing recurrent subluxation or lateral instability of the knee characterized as slight.  There was no evidence of painful motion with functional loss supporting a 10% rating (based on §4.59, §4.40 and §4.45).  There likewise was no limitation of motion which attained a 10% rating under the diagnostic codes for limitation of flexion or extension (5260, 5261).  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).  No additional functional limitation was evidenced by the examinations.  Therefore the panel concluded there was insufficient evidence to support a rating higher than the 0% adjudicated by the PEB.  

BOARD FINDINGS: In the matter of the right knee condition 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 20170213, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Record 

AR20180004697, 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.

Sincerely,					      
Enclosure