RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2017-01796
BRANCH OF SERVICE:  Army	SEPARATION DATE:  20080318

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E5, Infantryman, medically separated for “chronic left knee patellar tendinitis” with a disability rating of 10%.  

CI CONTENTION:  “Rated at 0% but was found unfit for service, should have been given a higher rate or an option to at least change MOS after 11 years 6 months, time in service.”  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 - 20080421	VARD - 20080703	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Left Knee Patellar Tendinitis	5024	10%	Left Patellofemoral Syndrome	5299-5260	10%	20080417	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  20%	

ANALYSIS SUMMARY:  

Chronic Left Knee Patellar Tendinitis.  According to the service treatment record and MEB narrative summary (NARSUM), the CI’s left knee condition began in April 2005 after slipping on ice.  Radiographic (X-ray) studies showed no evidence of traumatic, arthritic, inflammatory, or neoplastic changes about the knee.  The joint space was adequately maintained and there was no loose body or joint effusion seen.  There was no surgical indication.  

At the 30 May 2007 MEB NARSUM, 10 months prior to separation, the CI reported left knee pain.  Physical examination showed tenderness over the anterior joint line and patellar tendon and there was patellar grind tenderness.  There was normal patellar glide with no patellar apprehension, and no knee laxity or instability (negative Lachman, posterior drawer, and McMurray).  The range of motion (ROM) was within normal limits.  Painful motion was not addressed.  During the 17 September 2007 MEB examination (recorded on DD Forms 2807-1 and 2808), 6 months prior to separation, physical examination showed full ROM of the bilateral knees.  There was pain and patellar grind on the left knee.  Drawer, Lachman’s, and McMurray’s tests were negative and the knee was stable to varus/valgus stress.  

At the 17 April 2008 VA Compensation and Pension (C&P) examination, 1 month after separation, the CI reported constant left knee pain rated 7/10 and that he used a knee brace.  Physical examination showed an abnormal gait, limping on the left leg.  There was tenderness, guarding of movement, and crepitus.  There was no edema, effusion, weakness, redness, heat, subluxation, no genu recurvatum, and no locking pain.  The ROM measurements showed a normal flexion of 140 degrees with pain and a normal extension of 0 degrees.  The knee was not additionally limited by the following after repetitive use:  fatigue, weakness, lack of endurance, and incoordination.  The anterior and posterior cruciate ligaments stability tests, medial and lateral collateral ligaments stability test, and medical and lateral meniscus test were within normal limits.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the left knee condition 10%, coded 5024 (tenosynovitis), citing tenderness and full ROM, with functional loss and flare-ups considered.  The VA also rated the left knee condition 10%, analogously coded 5260 (leg, limitation of flexion), based on the C&P examination, citing objective evidence showing pain produced at 140 degrees flexion, negative X-ray, tenderness, guarding, and crepitus.  

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), 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).  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 chronic left knee patellar tendinitis condition. 

BOARD FINDINGS:  In the matter of the chronic left knee patellar tendinitis 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 20170301, w/attachments
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Record

AR20180005846, 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