RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME: XXXXXXXXXXXXXXXXXX	CASE:  PD-2017-02473
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20080201

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E-5, Abrams Tank System Maintainer, medically separated for “patellofemoral pain syndrome, right” with a disability rating of 10%.   

CI CONTENTION:  “I developed PTSD [post-traumatic stress disorder] from events that took place in Iraq.  They did not want to treat it, even though I was already showing symptoms.  I couldn’t perform my duties because of this and my injuries.”  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 - 20090220	VARD - 20081007	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Patellofemoral Pain Syndrome, Right	5099-5003	10%	Right Knee Strain with Patellar Tendonitis and Chondromalacia	5299-5260	10%	20081211	
PTSD	Not Unfitting	PTSD	9411	NSC	STR	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  30% 	

ANALYSIS SUMMARY:  

Right Patellofemoral Pain Syndrome (PFPS).  According to the service treatment record and MEB narrative summary (NARSUM), the CI’s PFPS began in June/July 2005 after falling from an observation tower while in full combat gear.  Starting in January 2007, the pain was constantly present.  X-rays of the right knee in March 2007 were normal.  The 25 October primary care examination noted the right knee showed no effusion, no swelling and no deformity.  There was tenderness over the medial patella and full range of motion (ROM) with pain when flexing the knee.  

The 19 November 2007 MEB NARSUM examination, 2 months prior to separation, noted complaints of sharp constant knee pain which increased with movement.  The CI received conservative therapy as well as a knee brace but there was no improvement.  Orthopedics noted no surgery was indicated.  Tramadol and Tylenol 3 were used as needed for pain.  Physical examination of the right knee showed tenderness with normal motion and sensation and no lower extremity weakness.  Gait and stance were normal.  Physical therapy ROM measured with a goniometer on 3 December 2007 noted flexion of 120 degrees (normal 140) an extension to 0 degrees (normal).  Limited motion was due to both pain and mechanical reasons (arthritic changes).   There was no evidence of instability.  

At the 23 September 2008 VA Compensation and Pension (C&P) examination, 9 months after separation, the CI reported right knee swelling and bilateral knee pain and stiffness, right greater than left.  He reported the right knee locked and buckled and felt weak at times, but not the left.   Right knee pain increased with weight bearing, activity, and weather changes.  Pain decreased with medications and getting off his feet.  He was no longer using a right knee brace.  He took aspirin and Tylenol as needed.  Physical examination showed a normal gait and the ability to toe and heel walk, fully squat and then stand.  Positive patellar compression test was mildly positive with tenderness of the patellar tendon.  ROM of the right knee revealed flexion of 135 degrees with pain.  DeLuca did not apply.  The right knee had full strength.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the PFPS 10%, analogously coded 5099-5003 (degenerative arthritis), citing pain-limited ROM.  The VA also rated the PFPS 10%, analogously coded 5299-5260 (leg, limitation of flexion) based on the C&P examination, citing painful reduced motion of the right knee joint.

There was no limitation of flexion or extension that supported a rating under the VASRD diagnostic codes for limitation of motion (5260 or 5261).  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).  However, there was evidence of painful motion with functional loss supporting a 10% rating (based on §§4.59, 4.40 and 4.45) from the PT MEB examination.  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 PFPS.  

Contended PEB Condition:  PTSD.  The panel’s main charge is to assess the fairness of the PEB determination that the contended condition was not unfitting.  The contended condition was not profiled or implicated in the commander’s statement and did not fail retention standards.  There was no performance-based evidence from the record that the condition 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 the contended condition, so no additional disability rating is recommended.    

BOARD FINDINGS:  In the matter of the right patellofemoral pain syndrome and IAW VASRD §4.71a, the panel recommends no change in the PEB adjudication.  In the matter of the contended PTSD, 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 20170226, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Record 

AR20190005991, 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