RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2017-02113
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20080214

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E3, Food Service Specialist Trainee, medically separated for “patellofemoral syndrome of the right knee” with a disability rating of 10%.  

CI CONTENTION:  Review requested of the right knee.  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 - 20090218	VARD -  NA	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Patellofemoral Syndrome of the Right Knee	5299-5257	10%	No VA Examination Proximate to Separation	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  NA	

ANALYSIS SUMMARY:  

Patellofemoral Syndrome of the Right Knee.  According to the service treatment record and Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s knee pain began in July 2007 without specific trauma.  Radiographic studies revealed mild lateral translation of the patella, but no evidence of bony degenerative changes or inadequate joint spaces; she was not a surgical candidate.  

At the initial physical therapy evaluation on 8 August 2007, 6 months prior to separation, the CI reported right anterior knee pain during the previous month and that she was unable to pass the physical fitness test or complete a 4-mile run.  On examination, she had an antalgic gait with decreased stance time on the right lower extremity.  There was tenderness along the patellar tendon, but no effusion, patellar grind, or instability.  McMurray and Apley testing for meniscal pathology was negative.  Motor strength was 4+ “extension (pain).”  Active right knee range of motion (ROM) showed flexion to 120 degrees (normal 140) with pain noted during passive motion to 130 degrees.  

At an orthopedic evaluation on 17 September 2007, the CI reported continued bilateral knee pain, right greater than left, but no popping, locking or giving way.  She experienced pain rated at 8/10 when running.  Physical examination of the knees showed tenderness, but no swelling, effusion, edema, erythema or warmth.  There was no crepitus of the patella or patellofemoral lateral tracking.  Bilateral ROM was noted as full with pain “elicited by motion of both knees in extreme end of flexion.” There was no muscle weakness, lateral instability or laxity, and anterior and posterior drawer tests were negative.  

During the 28 November 2007 MEB NARSUM examination, 2 months prior to separation, the CI reported continued right knee pain which she rated at 8/10 when running, squatting, kneeling, climbing and wearing a rucksack or body armor.  Physical examination showed tenderness, but no edema, effusion or patellar crepitus.  Patellar apprehension and passive patellar tilt tests were negative as were Lachman, drawer, McMurray and pivot shift tests.  There was no evidence of atrophy, medial and collateral ligaments were intact, , deep tendon reflexes were 2+ and equal, and sensation was intact to light touch in all dermatomes in the lower extremity.  Measured ROM showed right knee flexion to 130 degrees.  At the MEB physical therapy ROM study on 7 December 2007, goniometrically measured right knee ROM was from 0-130 degrees.  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 10%, analogously coded 5299-5257 (knee, other impairment of), citing minor functional loss caused by pain.  Panel members agreed that while there was no limitation of flexion or extension which supported ratings under 5260 or 5261, 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), history of surgery to remove a meniscus (5259), fracture, nonunion or mal-union 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. 

BOARD FINDINGS:  In the matter of the patellofemoral syndrome of the right knee 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 20170307, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Record

AR20180016651, 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