RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  xxxxxxxxxxxxxxxxx	CASE:  PD-2017-04131
BRANCH OF SERVICE:  Army	SEPARATION DATE:  20050519

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E6, Field Artillery Surveyor, medically separated for “right knee retropatellar pain syndrome” with a disability rating of 0%.  

CI CONTENTION:  Review all conditions.  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 - 20050421	VARD - 20060214	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Right Knee Retropatellar Pain Syndrome	5099-5003	0%	Patellofemoral Syndrome, Right Knee	5260-5014	10%	20050811	
COMBINED RATING:  0%	COMBINED RATING OF ALL VA CONDITIONS:  70%	

ANALYSIS SUMMARY:  

Right Knee Retropatellar Pain Syndrome.  According to the service treatment record and MEB narrative summary (NARSUM), the CI’s right knee condition began in August 1998 after a road march.  An MRI in April 2002 found no evidence of meniscal tear or significant ligamentous injury, but X-rays in December 2004 revealed a slightly lateral patella.  At the 22 December 2004 orthopedics consult, 5 months prior to separation, the CI complained of worsening right knee pain with stiffness, swelling and giving way.  Physical examination showed no effusion or laxity and provocative testing was negative for ligamentous instability or meniscal pathology.  Gait and range of motion (ROM) where both normal.  However, there was tenderness in the area of the patellofemoral joint and also around the medial joint line.  

The 9 March 2005 MEB NARSUM examination, 2 months prior to separation, noted complaints of constant 7/10 right knee pain, worsening to 10/10 with prolonged standing, sitting, walking, climbing stairs, squatting and impact activities.  The examiner noted the CI had genu valgus that existed prior to service, but right knee pain did not exist prior to service.  Physical examination showed moderate tenderness about the lateral aspect of the knee.  Provocative testing for patellar instability was positive as was the retro patellar grind test.  Right knee ROM testing by physical therapy on 18 March 2005 showed painful limitation of flexion to 112 degrees (normal 140) and 0 degrees of extension (normal), after three repetitions. 

At the 11 August 2005 VA Compensation and Pension (C&P) joints examination, 3 months after separation, the CI reported chronic right knee pain with stiffness, swelling, intermittent locking and giving way.  Physical examination showed ROM of 0-130 degrees with no pain even with repetitive movement.  

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 ROM of 0-121 degrees with pain.  The VA rated the right knee condition 10%, dual coded 5260-5014 (limitation of leg flexion due to osteomalacia), based on the C&P examination, citing painful or limited motion of a major 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) as shown in the orthopedic and MEB NARSUM examinations.  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 right knee condition, coded 5099-5003.  

BOARD FINDINGS:  In the matter of the right 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	
Right Knee Retropatellar Pain Syndrome	5099-5003	10%	

The following documentary evidence was considered:

AR20190007256, XXXXXXXXXXXXXXXXXXXX

Dear XXXXXXXXXXXXXXXXXXXXXX:

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.