RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2017-01995
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20081019

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E-5, Human Resources Specialist, medically separated for “right patellar tendinitis” 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 - 20080703	VARD - 20081124	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Right Patellar Tendinitis…	5099-5024	10%	Right Patellar Tendinitis	5260-5024	NSC	20080920	
Chronic Right Thumb Pain	Not Unfitting	S/P Right Thumb Dislocation	5228	NSC		
Chronic Low Back Pain		Lumbar Strain	5237	20%		
Headaches		Tension Headaches	8199-8100	NSC		
Adjustment Disorder…		Post-Traumatic Stress Disorder	9411	10%		
Alcohol Abuse		No VA Placement	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  30%	

ANALYSIS SUMMARY:  

Right Patellar Tendinitis.  According to the service treatment record (STR) and MEB narrative summary (NARSUM), the CI’s right knee condition began in February 2004 after falling during a training event.  He reinjured his right knee while in Iraq upon dismounting from a 5-ton truck in full combat gear.  The CI’s chronic right knee pain became worse secondary to an increased operations and training tempo in December of 2006.  

In the 25 March 2008 orthopedic MEB consult, 7 months prior to separation, were reported complaints of right knee pain that caused difficulty running up and down hills, navigating stairs, and squatting, worsened by carrying weight.  Physical examination revealed that the knee was tender at the patellar tendon.  Testing for meniscal damage was negative.  Range of motion (ROM) was recorded as normal, as were strength and neurologic examinations.  

During the 14 April 2004 MEB examination (recorded on DD Forms 2807-1 and 2808), 6 months prior to separation, physical examination showed tenderness of the patellar tendon with no effusion (fluid buildup in the joint).  Testing was negative for pain in the patellofemoral joint (negative grind test) and meniscal damage was negative.  ROM was recorded as full.  

At the 20 September 2008 VA Compensation and Pension (C&P) evaluation, one month before separation, the CI reported right knee pain (5/10 in severity) with weakness, giving way, and fatigability, which limited running, squatting, bending, crawling, and lifting with his legs.  Physical examination showed gait and posture within normal limits.  The knee was tender, but there were no signs of swelling, fluid in the joint, weakness, or guarding of movement, and there was no subluxation (temporary dislocation).  There was no locking pain or crepitus (crackling or grinding noise or sensation).  ROM was recorded as 0-140 degrees (normal), and was not further limited by pain, fatigue, weakness, lack of endurance or incoordination after repetition.  Testing for meniscal damage was negative.  X-rays were negative.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the right knee at 10%, coded 5099-5024 (analogous to tenosynovitis), citing “…local tenderness and satisfactory evidence of painful motion.”  The VA initially determined the condition was not service connected, but in 2012 also rated the right knee at 10% coded 5260-5024 (limitation of leg motion - tenosynovitis) effective the day after separation, based on an appeal by the CI, citing reported pain and objective evidence of tenderness.  

The panel noted 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 VASRD §§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 rating higher than the 10% adjudicated by the PEB under any applicable code.  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.  

Contended PEB Conditions:  Chronic Right Thumb Pain, Chronic Low Back Pain, Headaches, Adjustment Disorder, and Alcohol Abuse.  The panel’s main charge is to assess the fairness of the PEB determination that the contended conditions were not unfitting.  None of the conditions were profiled, implicated in the commander’s statement as affecting the performance of duties, or 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 right knee condition and IAW VASRD §4.71a, the panel recommends no change in the PEB adjudication.  In the matter of the contended chronic right thumb pain, chronic low back pain, headaches, adjustment disorder, and alcohol abuse, the panel recommends no change from the PEB determination 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 20170227, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Record

AR20180010723, 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