RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2017-01717
BRANCH OF SERVICE:  ARMY 	SEPARATION DATE:  20090809

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E4, Multiple Launch Rocket System Crewmember, medically separated for “left knee, patellofemoral syndrome” 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 – 20090504	VARD - 20091005	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Left Knee Patellofemoral Syndrome	5099-5003	10%	Left Knee Strain	5260	10%	20090724	
Hypertension	Not Unfitting	Hypertension	7101	0%	20090724	
Headaches	Not Unfitting	Tension Headaches	8199-8100	0%	20090724	
Musculoskeletal Chest Pain	Not Unfitting	Costochondritis	5399-5321	0%	20090724	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  50%	

ANALYSIS SUMMARY:  

Left Knee Patellofemoral Syndrome.  According to the service treatment record and MEB narrative summary (NARSUM), an MRI in November 2008 showed a medial meniscal tear.  Orthopedics diagnosed the CI with an acute medial meniscal tear, and he underwent arthroscopy of the left knee on 6 February 2009.  However, it is unclear what the operative findings were and exact procedures performed, as the operative note is not available for review and there is only one post-operative note in evidence which did not provide that information.  At the MEB orthopedic consultation on 7 January 2009, 1 month before surgery, the CI reported daily pain aggravated by running, going up and down stairs, squatting, sitting, and standing.  He also reported “somewhat of a grinding sensation” and a history of the knee giving out after a sense of pain.  There were no complaints of locking.  Physical examination showed global tenderness around the patella but the CI had normal patellar tracking.  Range of motion (ROM) testing of the left knee showed flexion of 130 degrees (normal 140) and extension of 0 degrees (normal), with very mild retropatellar crepitus.  Provocative testing to elicit meniscal pathology was negative.  The examiner diagnosed left knee pain consistent with patellofemoral syndrome and stated there were no meniscal signs on examination.  

During the 27 February 2009 MEB examination (recorded on DD Forms 2807-1 and 2808), 3 weeks after surgery and 6 months prior to separation, the examiner recorded normal gait with full active ROM of the left knee.  Patellar grind was positive, but there was no effusion.  The 23 March 2009 MEB NARSUM examination, 5 months prior to separation, noted complaints of constant, stabbing, and radiating-type pain behind the patella as well as deep within the joint, which was aggravated by running, jumping, impact activities, standing greater than 30 minutes, and other activities.  The CI reported his condition had deteriorated since his arthroscopic surgery in early February.  The examiner repeated information provided in the 7 January 2009 MEB consultation and the 27 February 2009 MEB examination, providing no new information.  

At the 24 July 2009 VA Compensation and Pension (C&P) examination, 2 weeks before separation, the CI reported bilateral knee weakness, stiffness, heat, giving way, lack of endurance, locking, fatigability, tenderness, effusion, and pain.  He denied swelling, redness, deformity, drainage, subluxation, and dislocation.  He reported experiencing flares of pain occurring up to 3 times daily and lasting for 2 hours, precipitated by physical activity.  Physical examination showed a normal gait.  The left knee had tenderness but no signs of edema, abnormal movement, effusion, weakness, redness, heat, deformity, guarding of movement, malalignment, drainage, or subluxation.  ROM measurements of the left knee after repetition showed flexion of 125 degrees and extension of 0 degrees with painful motion noted.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the left knee condition 10%, coded 5099-5003 (analogous to degenerative arthritis), citing painful motion.  The VA also rated the left knee condition 10%, coded 5260 (limitation of flexion of the leg), based on the C&P examination, citing painful or limited motion.  

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).  There was no history or evidence of dislocated meniscus or loose body causing frequent locking with recurrent effusions (5258) to support a rating under those codes.  There is a questionable history of surgery to remove a meniscus (5259); however, panel members note that this only provided a maximum 10% rating which did not constitute a rating advantage to the CI.  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).  There was therefore no VASRD §4.71a route to a rating higher than the 10% adjudicated by the PEB under any applicable code.  After due deliberation, considering all of 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 condition.  

Contended PEB Conditions:  Hypertension, Headaches, Musculoskeletal Chest Pain.  The panel’s main charge is to assess the fairness of the PEB’s determination that the contended conditions were not unfitting.  None of the conditions were profiled, implicated in the commander’s statement, nor judged to fail retention standards.  There was no performance-based evidence from the record that any of the conditions significantly interfered with satisfactory duty performance at separation.  After due deliberation, the panel concluded there was insufficient cause to recommend a change in the PEB fitness determination for any of the contended conditions, so no additional disability ratings are recommended.  

BOARD FINDINGS:  In the matter of the left knee condition and IAW VASRD §4.71a, the panel recommends no change in the PEB adjudication.  In the matter of the contended hypertension, headaches, and chest conditions, the panel recommends no change from the PEB determinations as not unfitting.  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 20170327, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Record 

AR20180005416, 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