RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2017-01309
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20080107

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E4, Bradley Fighting Vehicle Systems Maintainer, medically separated for “patellar subluxation” with a disability rating of 10%.  

CI CONTENTION:  Review all conditions.  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 - 20071116	VARD - 20080620	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Left Patellar Subluxation	5299-5257	10%	Left Patellar Subluxation	5257	10%	20080425	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  20%	

ANALYSIS SUMMARY:  

Patellar Subluxation.  According to the service treatment record (STR) and MEB narrative summary (NARSUM), the CI’s left knee condition began in April 2003 while marching with full combat gear.  Orthopedic evaluation on 15 March 2004 revealed the CI had a lateral patellar dislocation.  An MRI demonstrated no significant joint injury, although there was a suspicion of some loose articular cartilage near the medial aspect of the patella (knee cap).  Arthroscopy was performed in April 2004.  The operative report was not in the STR; however, the CI reported a piece that was about the size of a “50 cent piece” (1.205 inches) was removed.  Postoperatively, he had symptoms of retropatellar pain syndrome.  On 17 January 2006 the CI complained of left knee locking up.  He had full range of motion (ROM).  On 7 February 2007 the CI reported constant pain and popping, snapping, and cracking of the knee.  On examination Apley’s compression test (to determine a meniscal tear) and Thessaly’s test (to detect a meniscal tear) were positive.  X-rays of the knees revealed no bony abnormalities.  An MRI dated 12 June 2007 was ordered for recurrent giving way and locking of the left knee for 3 years, and demonstrated a small fissure in the femoral articular cartilage with patella at the apex. 

During the 25 June 2007 MEB examination (recorded on DD Forms 2807-1 and 2808), 7 months prior to separation, the CI reported knee trouble.  Physical examination revealed left knee pain with movement and weight bearing.  The 15 October 2007 MEB NARSUM examination, 3 months prior to separation, noted complaints of chronic left knee pain.  The examiner noted the CI was seen in July 2007 by orthopedics with the recommendation of future possible surgery for the small fissure in the femoral articular cartilage.  Physical examination of the left knee showed tenderness of the patella, but no swelling of the anterior knee.  The range of motion (ROM) was limited to 0-100 degrees (normal 0-140).  There was no laxity or crepitus (grinding sensation).  

At the 25 April 2008 VA Compensation and Pension (C&P) examination, 3 months after separation, the CI reported left knee pain which was treated with etodolac (an NSAID) and tramadol (an opioid-like medication).  Physical examination showed the left knee ROM was 0-120 degrees with crepitus.  There was no laxity, but there was joint line tenderness medially.  X-rays of both knees on 28 April 2008 were radiologically normal.  The examiner’s diagnostic impression was left patellar subluxation.  

At a VA examination on 18 December 2008, 11 months after separation, the CI reported pain mainly around the entire aspect of his left proximal tibia with a severity of 7-8/10 (10 being the worst pain).  Examination revealed 5 degrees of hyperextension with flexion of 0-140 degrees (normal 0-140).  There was no laxity or evidence of a meniscal tear.  There were positive patellar grind (to determine patellofemoral pain syndrome) and patellar apprehension (to determine whether symptoms were from a subluxing or dislocating patella) tests with mild crepitus in the patellofemoral joint.  His knee was tender at both the medial and lateral joint lines as well as posteriorly and he was unable to do a one limb squat on the affected extremity.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the left knee condition 10%, analogously coded 5299-5257 (recurrent subluxation or lateral instability), citing painful motion.  The VA also rated the left knee condition 10%, coded 5257, based on the C&P examination, citing slight recurrent subluxation or lateral instability of the knee.

Panel 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).  However, at the time of separation there was no significant subluxation or lateral instability of the knee (5257).  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 the respective codes.  He had a loose body removed, but did not have frequent locking or recurrent effusions.  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 other VASRD §4.71a applicable code offered a rating higher than the 10% adjudicated by the PEB.  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 left patellar subluxation knee condition.  

BOARD FINDINGS:  In the matter of the left patellar subluxation 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 20170310, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Record 

AR20180008631, 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