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Dear XXXXXXXXXX:

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. 

RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXX	CASE:  PD-2017-03787
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20070119

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects this covered individual (CI) was a Reserve E5, Automated Logistical Specialist, medically separated for “left knee patellofemoral pain” with a disability rating of 0%.  

CI CONTENTION:  No specific contention was made.  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 – 20061023	VARD - NA	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Left Knee Patellofemoral Pain	5099-5003	0%	No VA Examination in Evidence 	
COMBINED RATING:  0%	COMBINED RATING OF ALL VA CONDITIONS:  NA	

ANALYSIS SUMMARY:  

Left Knee Patellofemoral Pain.  According to the service treatment record and MEB narrative summary (NARSUM), the CI’s left knee condition began in November 2004 while running.  The left knee MRI revealed chondromalacia of the patellofemoral joint and early degenerative changes of the medial compartment.  Surgery was not recommended.  

At the time of the orthopedic sports clinic appointment on 19 September 2005, the CI reported chronic left anterior knee pain.  The examiner stated symptoms were unchanged from previous appointment in June 2005.  Range of motion (ROM) was recorded as 130 degrees of flexion (normal 140) and 0 degrees of extension (normal).  There was minimal effusion.  

The 21 October 2005 MEB NARSUM examination noted complaints of swelling and giving way.  Physical examination showed normal knee alignment, but there was crepitus and a hesitant gait.  ROM was flexion of 125 degrees and extension of 5 degrees.  The CI was seen on 21 July 2006 to update the NARSUM.  The examiner reported the knee symptoms had not changed.  The CI wore a patella cut-out brace for support due to reports of knee giving out.  The CI had flexion of 107 degrees, after repetition, and extension of -26 degrees, after repetition, due to pain.  There was no effusion.  Patellofemoral tracking was normal.  The CI was very sensitive and complained of severe pain with compression or manipulation of the patellofemoral joint.  

The CI was seen again by the same NARSUM examiner on 14 December 2006, 1 month before separation and after the PEB.  A new X-ray was done because of reported worsening of symptoms.  There was a small lateral spur on the skyline view of the left patella.  On tunnel views there were tiny spurs in the notches which the examiner stated were not abnormal in an adult.  Active ROM was flexion of 88 degrees and extension of 1 degree.  The examiner noted less than full quadriceps effort and noted pain and guarding of the quadriceps.  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 left knee condition 0%, analogously coded 5099-5003 (arthritis, degenerative), citing pain with movement.  Although there was evidence of severe limitation of left knee extension (-26 degrees), the panel placed more probative value on the 14 December 2006 pre-separation NARSUM ROM evaluation, which was more proximate to separation and showed essentially normal extension (5261). There was no limitation of flexion that supported a rating under VASRD diagnostic code 5260.  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).  After due deliberation, considering all 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 left knee condition, the panel recommends a disability rating of 10%, coded 5099-5003 IAW VASRD §4.71a.  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	
Left Knee Patellofemoral Pain	5099-5003	10%	

The following documentary evidence was considered: