RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2017-01578
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20080311

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E4, Automated Logistical Specialist, medically separated for “recurrent patellar dislocation/subluxations following fracture, right tibia” with a disability rating of 20%.

CI CONTENTION:  No specific contention was made.  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 - 20090227	VARD - 20090518	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Recurrent Patellar Dislocation…	5299-5257	20%	Right Leg Surgery Residuals	5257	0%	STR	
COMBINED RATING:  20%	COMBINED RATING OF ALL VA CONDITIONS:  0%	

ANALYSIS SUMMARY:

Recurrent Patellar Dislocation/Subluxations.  According to the service treatment record (STR) and MEB narrative summary (NARSUM), the CI was struck by a tire causing a right patella dislocation (date not provided) which easily recurred with twisting motions, and was treated with physical therapy and a knee brace.  His right tibia condition began in June 2005 after being struck by a fork lift in Iraq.  He underwent surgery for a closed right distal tibia/fibula shaft fracture with manipulation and intramedullary (IM) nail and rod.  Hardware removal was scheduled in January 2007 due to pain, but the IM nail could not be removed, and the CI continued to have leg and knee pain.  At a physical therapy appointment on 21 September 2007, 6 months prior to separation, the CI reported right knee pain.  Physical examination revealed a mildly antalgic gait and inability to heel-toe walk due to pain.  Right knee range of motion (ROM) was within normal limits and strength was 4/5 due to calf pain.  

During the 19 November 2007 MEB examination (recorded on DD Forms 2807-1 and 2808), 4 months before separation, the provider noted an antalgic gait and inability to heel-toe walk due to pain.  There was anterior and lateral tibia tenderness, but no swelling or effusion.  Right knee motor strength was decreased to 4/5, and ROM was full but painful.  The 29 November 2007 MEB NARSUM examination documented constant, moderate right knee and patella pain aggravated by running, walking over a half a mile, and driving.  Twisting motions caused the patella to “jump out,” and although the CI wore a patellar stabilizing brace, he experienced subluxations/dislocations about once a week.  He was not taking medication due to religious beliefs.  Physical examination showed right knee patellar tendon tenderness, crepitance, and effusion.  Patellar instability testing was positive, but meniscus and knee instability testing was negative.  Repetitive right knee ROM was flexion to 120 degrees (normal 140) and extension to 0 degrees (normal), with painful motion.  Right knee and leg X-rays showed a slight femoral condyle (bony side of the upper knee) irregularity and healed tibia and fibula fractures with retained IM nail.  There was no VA examination proximate to separation in evidence.

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the right knee condition 20%, analogously coded 5299-5257 (knee, other impairment), citing decrease in subluxations to about once a week.  The VA rated the right knee condition 0%, also coded 5257, based on the STR, citing a noncompensable evaluation due to failure to report for a scheduled VA examination.  Members agreed that the CI’s use of a stabilizing brace, weekly subluxations/dislocations, and positive patellar instability testing most approximated a “moderate” patellar instability to support the 20% rating adjudicated by the PEB.  Additionally, there was no limitation of motion (5260, 5261), meniscal surgery (5259), evidence of dislocated meniscus or loss body causing frequent locking with recurrent effusions (5258), or fracture, nonunion or malunion of the femur or tibia causing a knee impairment (5255, 5262) to support a higher rating under those codes.  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 condition.

BOARD FINDINGS:  In the matter of the recurrent patellar dislocation/subluxations following right tibia fracture 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 20170227, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Record

AR20180010644, 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