RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2017-01328
BRANCH OF SERVICE:  Army	SEPARATION DATE:  20080501

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E3, Wheeled Vehicle Mechanic, medically separated for “patellofemoral pain syndrome secondary to bipartite patella left knee” 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 - 20080215	VARD - 20081112	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Left Patellofemoral Pain Syndrome	5099-5003	10%	Left Knee Bipartite Patella…	5010-5260	10%	20081006	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  30%	

ANALYSIS SUMMARY:

Left Knee Patellofemoral Pain Syndrome.  According to the service treatment record and MEB narrative summary (NARSUM), the CI’s left knee condition began in September 2006 while performing physical training at advanced individual training without a specific injury.  Radiographic imaging (MRI) showed left knee bipartite patella with mild reactive marrow edema.  Evidence of meniscal instability was not present.

The 4 December 2004 MEB NARSUM examination, 4 months prior to separation, noted complaints of left knee pain.  Physical examination showed left patella tenderness.  Flexion was 110 degrees (normal 140) and extension was 0 degrees (normal); painful motion was present.  At the 2 July 2008 VA Compensation and Pension (C&P) general examination, 2 months after separation, the CI complained of daily right knee pain.  Physical examination revealed a normal gait without use of an ambulatory aid or brace.  There was no edema, effusion, instability, weakness, or tenderness present.  Flexion was 110 degrees and extension was 0 degrees; painful motion was not present.  There was no loss of ROM with repetitive use.

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the left knee condition 10%, analogously coded 5099-5003 (arthritis, degenerative), citing imaging and pain-limited motion.  The VA also rated the left knee condition 10%, coded 5010-5260 (degenerative arthritis due to trauma-leg, limitation of flexion), based on the C&P examination, citing functional loss due to pain.

The panel 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 painful motion with functional loss to support the 10% rating based on §4.59, §4.40, and §4.45.  There was no history 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.  There was no fracture, non-union, 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 higher VASRD §4.71a rating option 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 knee patellofemoral pain syndrome condition.

BOARD FINDINGS:  In the matter of the left patellofemoral pain syndrome 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

AR20180007717, 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