RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2017-04782
BRANCH OF SERVICE:  Army	SEPARATION DATE:  20090527

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E7, Infantryman, medically separated for “chronic left knee patellofemoral pain syndrome” with a disability rating of 10%.  

CI CONTENTION:  Condition continues to worsen and negatively affects physical activity.  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 - 20090311	VARD - 20090818	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Left Knee Patellofemoral Pain Syndrome	5099-5003	10%	Chondromalacia Patellofemoral Pain Syndrome/Torn Meniscus, Left Knee	5010	10%	20090611	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  10%	

ANALYSIS SUMMARY:  

Chronic Left Knee Patellofemoral Pain Syndrome.  According to the service treatment record and MEB narrative summary (NARSUM), the CI’s left knee condition began in June 2007 and was associated with running and biking.  He was able to deploy and was treated with glucosamine/chondroitin sulfate and a nonsteroidal anti-inflammatory medication.  Post-deployment X-rays, dated 20 January 2009, showed no evidence of fracture, dislocation, abnormality, or effusion.  A left knee MRI the same day showed a probable, small tear in the medial meniscus, peripherally placed.  

At an orthopedic clinic visit on 20 January 2009, 4 months prior to separation, the CI’s left knee range of motion (ROM) showed flexion of 130 degrees (normal 140) and extension of 0 degrees (normal).  There was tenderness over the anterior knee along with a patellar grind/shrug, but no laxity, effusion, or abnormal patellar tracking.  The examiner’s assessment was symptomatic, activity limiting, left knee retropatellar pain syndrome and a likely tear of the posterior horn of the medial meniscus, not symptomatic.  No surgical options were available at that time.  

The 26 February 2009 physical therapy clinic ROM measurements for the MEB showed 124 degrees of flexion and 0 degrees of extension.  Flexion changed by 4 degrees after repetition, but the examiner did not indicate whether it increased or decreased.  There was no mention of painful motion.  

During the 4 March 2009 MEB NARSUM examination, 2 months prior to separation, the CI complained of daily knee pain, with a severity of 2-4/10, and one or two episodes monthly of “giving out.”  Physical examination showed a normal gait and the ability to “walk on heels and tippy toes.”  There was a positive grind on patellar compression and patellar tenderness anteriorly, superiorly, and medially, but no increased mobility or effusion.  The left knee was ligamentously stable and had normal strength.  The examiner diagnosed left knee patellofemoral pain syndrome and medial meniscal tear.  

At the 11 June 2009 VA Compensation and Pension (C&P) examination, 2 weeks after separation, the CI reported daily, mild left knee pain, and flare-ups with moderate and persistent pain 2-3 times per week, but no loss of motion or function.  Physical examination showed a normal gait with no evidence of arthritis, but there was crepitus (grinding sensation).  The ROM evaluation showed flexion of 120 degrees and extension of 0 degrees.  There was pain with flexion, but no loss of motion due to repetition, and he was able to squat to 60 degrees with pain.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the left knee condition 10%, analogously coded 5099-5003 (degenerative arthritis), citing limitation of motion.  The VA rated the left knee condition 10%, coded 5010, based on the C&P examination, citing painful or limited motion of a major joint.  Members agreed there was no limitation of flexion or extension which supported a ratings under the diagnostic codes 5260 or 5261.  However, there was evidence of painful motion with functional loss supporting a 10% rating (based on §4.59, §4.40 and §4.45).  There was no history or evidence of dislocated meniscus or loose body causing frequent locking with recurrent effusions (5258; history of surgery to remove a meniscus (5259); or 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).  There was therefore no VASRD §4.71a rating higher than the 10% adjudicated by the PEB under any applicable code.  After due deliberation, considering all of 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 left knee patellofemoral pain syndrome condition.  

BOARD FINDINGS:  In the matter of the chronic left 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.

The following documentary evidence was considered:

 [AR NUMBER], 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.

Enclosure