RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2017-00837
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20061219

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E3, Indirect Fire Infantryman, medically separated for “chronic right patellar tendonitis” with a disability rating of 0%.  

CI CONTENTION:  The CI requested review of 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 PEB to be unfitting for continued military service, and when specifically requested by the CI, those conditions identified by the 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 - 20061122	VARD - 20070626	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Right Patellar Tendonitis	5024	0%	Right Patella Tendonitis	5024	10%	20070222	
COMBINED RATING:  0%	COMBINED RATING OF ALL VA CONDITIONS:  10%	

ANALYSIS SUMMARY:  

Chronic Right Patellar Tendonitis.  According to the service treatment record (STR) and MEB narrative summary (NARSUM), the CI’s right knee condition began in May 2005 during initial entry training.  At the time of the physical therapy clinic appointment on 23 May 2006, 7 months prior to separation, the CI reported chronic right knee pain.  On examination there was no swelling of the knee and the CI’s gait was normal.  There was mild tenderness over the patellar tendon with increased tenderness of the anterior joint medial and lateral to the patellar tendon.  There was significant tenderness over the medial and lateral patellar facets.  The CI had full active right knee range of motion (ROM) and he was able to perform a functional squat.  Anterior knee pain was noted at the end range of the squat.  

An MRI on 25 July 2006, 5 months prior to separation, revealed thickening and abnormal signal within the patellar tendon and some fragmentation of the tibial tuberosity at the insertion of the patellar tendon.  The finding may have been related to an old injury, chronic tendonitis, or unresolved Osgood-Schlatter’s disease process.  There was minimal effusion, mild chondromalacia patella, and minimal patellofemoral arthritis.  

During the 13 November 2006 MEB examination (recorded on DD Forms 2807-1 and 2808), 1 month prior to separation, the CI reported chronic right knee pain.  Physical examination showed bilateral crepitus, pain with right patella palpation, and right knee pain with motion and strength testing.  The 14 November 2006 MEB NARSUM examination, 1 month prior to separation, noted complaints of constant right knee pain (6/10) with daily activities that increased to 8/10 when he tried to ride a bike or walk fast.  The CI reported that twice a week he had difficulty falling asleep due to pain.  Right knee ROM, measured by physical therapy on 30 October 2006, showed flexion of 100 degrees (normal 140) and extension of 0 degrees (normal).  Painful motion (7/10) was noted with flexion and extension.  

At the 3 February 2007 VA Compensation and Pension (C&P) examination, 3 months after separation, the CI reported constant chronic daily right knee pain.  Flare-ups occurred approximately once a week and pain (4/10) tended to last one hour.  There was occasional swelling of the knee, but he denied locking or instability.  Physical examination showed tenderness over the inferior pole of the patella extending inferiorly over the patellar tendon to where it inserted on the proximal tibia.  Otherwise, the knee was non tender with a normal Lachman’s test, anterior drawer test, posterior drawer test, and McMurray’s test.  There was no crepitus, no joint warmth, effusion, or erythema.  Right knee ROM after repetitive motion showed flexion of 140 degrees and extension of 0 degrees.  There was no pain with any ROM.  

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 range of motion limited by pain.  The VA rated the right knee condition 10%, coded 5024, based on the C&P examination, citing painful motion of the right knee with a diagnosis of right patella tendonitis.  There was no limitation of flexion or extension that supported a rating under the VASRD diagnostic codes for limitation of motion (5260 or 5261).  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 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).  However, there was evidence of painful motion with functional loss supporting a 10% rating (based on §§4.59, 4.40, and 4.45).  After due deliberation, considering all the evidence and mindful of VASRD §4.3 (reasonable doubt), the panel recommends a disability rating of 10% for the right knee condition, coded 5024.  

BOARD FINDINGS:  In the matter of the right knee condition, the panel 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 the CI’s prior determination be modified as follows, effective the date of medical separation:  

CONDITION	VASRD CODE	PERMANENT RATING	
Chronic Right Patellar Tendonitis	5024	10%	

AR20180013148, XXXXXXXXXXXXXXXXXX

XXXXXXXXXXXXXXXXXX

Dear XXXXXXXXXXXXXXXXXX

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.