RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2017-02929
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20070513

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E4, Infantryman, medically separated for “chronic knee pain due to femoropatellar syndrome” with a disability rating of 0%.

CI CONTENTION:  “I was given a medical discharge due to a knee injury.  I went through a lot of physical therapy while still on Active Duty but was given a 0% rating by the Army.”  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 - 20070322	VARD - 20070706	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Knee Pain Due to Femoropatellar Syndrome	5099-5003	0%	Chronic Left Knee Strain with Femoropatellar Syndrome	5014-5260	10%	20070418	
COMBINED RATING:  0%	COMBINED RATING OF ALL VA CONDITIONS:  10%	

ANALYSIS SUMMARY:  

Chronic Knee Pain.  According to the service treatment record (STR) and MEB narrative summary (NARSUM), the CI’s left knee condition began in March 2005 after he fell and sustained blunt trauma and a contusion.  Diagnostic imaging of the knee in 2005 and 2006 was normal.

During the 4 December 2006 MEB examination (recorded on DD Forms 2807-1 and 2808), 5 months prior to separation, the CI reported pain with occasional swelling after any strenuous activity.  Physical examination showed range of motion (ROM) from 0-130 degrees (normal 0-140) for both knees, and no tenderness or instability. At the 16 January 2007 MEB NARSUM examination, the CI complained of left knee pain under the mid patella, which increased with prolonged walking, repeated knee bending, climbing up and down stairs, and any impact activity.  The provider repeated the MEB examination findings, and additionally reported results of a July 2006 orthopedic evaluation which noted slight left knee effusion with normal patellar motion and no tenderness.  Instability was not present, but there was a clicking or shifting during motion. 

At the 18 April 2007 VA Compensation and Pension (C&P) examination, 1 month before separation, the CI reported pain with physical activity, weakness with prolonged or running, stiffness after over use, and giving way on uneven surfaces.  Physical examination revealed a normal gait and posture, and no crepitus, edema, effusion, tenderness, guarding, subluxation, atrophy or instability.  Measured ROM showed flexion to 122 degrees and extension to 0 degrees.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the left knee condition 0%, analogously coded 5099-5003 (degenerative arthritis), citing full ROM and no instability.  The VA rated the left knee condition 10%, analogously coded 5014-5260 (osteomalacia-leg, limitation of flexion), citing painful or limited motion of a major joint.  Members agreed 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 of removal of loose body, or dislocated meniscus causing frequent locking with recurrent effusions or history of surgery to remove a meniscus to support a rating under code 5258 or 5259.  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, the C&P examination documented evidence of painful motion with functional loss supporting a 10% rating (based on §4.59, §4.40 and §4.45).  After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the panel recommends a disability rating of 10% for the left knee condition, coded 5099-5003.  

BOARD FINDINGS:  In the matter of the chronic knee pain due to femoropatellar syndrome condition, the panel recommends a disability rating of 10%, coded 5099-5003 IAW VASRD §4.71.  There are no other conditions within the panel’s scope of review for consideration.  

The panel recommends the CI’s prior determination be modified as follows, effective the date of medical separation:  

CONDITION	VASRD CODE	PERMANENT RATING	
Chronic Knee Pain due to Femoropatellar Syndrome	5099-5003	10%	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20170422, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Record 

AR20180008799, XXXXXXXXXXXXXXXXXX

XXXXXXXXXXXXXXXXXX

Dear XXXXXXXXXXXXXXXXXX

The Department of Defense Physical Disability Board of Review (DoD PDBR) reviewed your application and found that your disability rating should be modified but not to the degree that would justify changing your separation for disability with severance pay to a permanent retirement with disability.  I have reviewed the Board’s recommendation and record of proceedings (copy enclosed) and I accept its recommendation.  This will not result in any change to your separation document or the amount of severance pay.  A copy of this decision will be filed with your Physical Evaluation Board records.  I regret that the facts of the case did not provide you with the outcome you may have desired.
  
	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. 

	A copy of this decision has also been provided to the Department of Veterans Affairs. 

Sincerely,					      
Enclosure