RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2017-04056
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20071122

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E6, Automated Logistical Specialist, medically separated for “chronic right knee patellofemoral pain syndrome” 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 - 20070813	VARD - 20090213	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Right Knee Patellofemoral Pain Syndrome	5099-5003	0%	Residuals of Right Knee Injury with Internal Derangement	5299-5019	10%	20081009	
COMBINED RATING:  0%	COMBINED RATING OF ALL VA CONDITIONS:  50% 	

ANALYSIS SUMMARY:  

Chronic Right Knee Patellofemoral Pain Syndrome. According to the service treatment record (STR) and MEB narrative summary (NARSUM), the CI’s right knee condition began in May 2005 after twisting it.  Examination on 23 May 2005 revealed a full active range of motion (ROM) without discomfort, but there was tenderness on the medial collateral ligament.  There was no laxity and the CI ambulated with a normal gait.  On 6 June 2005, the CI reported pain associated with swelling during jogging and stair climbing.  The CI was referred to physical therapy (PT) and given a 14-day profile.  X-rays showed a normal right knee series.  On 3 August 2005, the CI had tenderness medially with some give/laxity when the medial collateral ligament was stretched.  A 24 August 2005 right knee MRI demonstrated a small joint effusion.  The medial and lateral collateral ligaments were normal as were the cruciate ligaments.  Popliteus bursitis (a fluid-filled sac) was noted at the posterior corners of the knee.  On 29 September 2005, the CI reported persistent pain despite medication and PT.  Naproxen, a nonsteroidal anti-inflammatory drug (NSAID) was prescribed.  On 31 March 2006 the CI reported the pain was worse.  On examination she had tenderness of the right medial femoral condyle and full ROM with pain at the end.  Orthopedic examination on 8 May 2006 revealed tenderness of the anterior and medial aspects of the right knee and at the joint line.  On 5 March 2007, examination findings were essentially unchanged.  There were no cruciate or collateral ligaments abnormalities or meniscal pathology.  

During the 2 April 2007 MEB examination (recorded on DD Forms 2807-1 and 2808), 8 months prior to separation, the CI reported right knee pain since 2005. Physical examination revealed a moderate effusion of the right knee without laxity or patellar apprehension.  Examination of the right knee 10 days later noted the patella demonstrated crepitus (grinding sensation) and an apprehension test was positive.  There was no effusion, warmth, or tenderness on the joint line.  There was no instability, pain with motion, or evidence of a meniscal tear.  The examiner’s assessment was chronic internal derangement of the right knee.  Use of glucosamine/chondroitin sulfate was discussed and meloxicam (an NSAID) was prescribed.  

The 3 May 2007 MEB NARSUM examination, less than 7 months prior to separation, noted the complaint of “my right knee pain,” which she rated at 8/10.  Physical examination showed a moderate effusion of the right knee with no evidence of laxity, and the patellar apprehension test was negative.  She was able to heel and toe walk easily as well as squat; she attempted to duck walk while holding onto a chair and the floor because of right knee pain.  X-rays of the right knee on 3 May 2007 were normal.  At a PT examination on 8 May 2007, the CI’s right knee ROM following repetitive movement was flexion of 117 degrees (normal 140) and extension of 0 degrees (normal) with pain.   

At the 11 October 2007 VA Compensation and Pension (C&P) examination, one month before separation, the CI reported symptoms of weakness, swelling, giving way, lack of endurance, and pain which was aching, cramping and sharp with a severity of 10/10 elicited by physical activity.  Physical examination showed a normal gait.  There was no edema, effusion, weakness, tenderness, redness, heat or abnormal movement.  There was no evidence of recurrent subluxation, locking pain, joint effusion or crepitus.  Right knee flexion and extension were normal.  Pain, weakness, lack of endurance, fatigue or incoordination did not impact ROM after repetition.   X-rays of the right knee showed no evidence for fracture or other significant bone, joint, or soft tissue abnormality.  

At the 9 October 2008 C&P examination, 11 months after separation, the CI reported occasional locking of the right knee and use of a right knee brace, but no cane.  The examiner found there was moderate anterior tenderness of the right knee and the right calf was approximately 2 cm smaller in circumference than the left.  The right knee flexion was 100 degrees with pain, and extension was normal.  After repetition flexion was 0-90 degrees with pain at 90 degrees. 

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the right knee condition 0%, analogously coded 5099-5003 (arthritis, degenerative), citing the U.S. Army Physical Disability Agency pain policy (AR 635-40), as pain slight and intermittent.  The VA also rated the right knee condition 0%, analogously coded 5299-5019 (bursitis), based on the C&P examination, citing full ROM without pain or instability at the knee joint.  By the time of the second C&P examination, the VA rated the right knee condition 10%, with the same analogous coding (bursitis), based on the C&P examination, citing objective evidence of painful or limited motion. 

The panel noted that proximate to separation there was no evidence of painful motion with functional loss supporting a 10% rating (based on §§4.59, 4.40 and 4.45). Although the CI had pain at the end of flexion less than 7 months prior to separation and had painful motion 11 months after separation, there was no explanation in the STR or VA examinations to account for that decrease in ROM with pain.  However, the ROM was normal without pain one month prior to separation.  Likewise, there was no limitation of motion which attained a 10% rating under the diagnostic codes for limitation of flexion or extension (5260, 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).  No additional functional limitation was evidenced by the examinations.  Therefore the panel concluded there was insufficient evidence to support a rating higher than the 0% adjudicated by the PEB.  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 chronic right knee patellofemoral pain syndrome condition.  

BOARD FINDINGS:  In the matter of the chronic right knee patellofemoral pain syndrome condition 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.  

AR20180016617, 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.