RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2017-05413
BRANCH OF SERVICE:  Army	SEPARATION DATE:  20090629

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E5, Infantryman, medically separated for “left patellofemoral syndrome evaluated as arthritis, degenerative” with a disability rating of 10%.  

CI CONTENTION:  Requested review of conditions not identified by the Medical Evaluation Board (MEB) and Physical Evaluation Board (PEB).  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 PEB to be unfitting for continued military service, and when specifically requested by the CI, those conditions identified by the 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 - 20090422	VARD - 20090826	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Left Patellofemoral Syndrome…	5099-5003	10%	Left Knee Patellofemoral Pain Syndrome, Osteoarthritis	5261-5003	10%	20090623	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  70%	

ANALYSIS SUMMARY:  

Left Patellofemoral Syndrome.  According to the service treatment record and MEB narrative summary (NARSUM), the CI’s left knee pain began in May 2006 after being struck by a moped.   On 20 November 2007, X-rays showed a normal left knee.  A 12 December 2008 orthopedic evaluation, 6 months prior to separation, noted complaints of a 2-year history of left knee patellofemoral joint pain.  The examiner recorded no instability and full, but painful, active range of motion (ROM).  Radiograph studies were within normal limits and showed no osteochondral defect.  The orthopedist stated the CI had recalcitrant retro-patellar pain following trauma, had maximized non-operative intervention, and did not meet criteria for surgical intervention.    

During the 10 March 2009 MEB examination, 3 months prior to separation, the CI reported constant, sharp stabbing pain in the peri- and retro-patellar areas, rated at 5/10.    It increased to 7-8/10 with activities such as walking upstairs, running, jumping, ruck marching.  Physical examination revealed a non-antalgic gait, tenderness, and no edema or laxity.  Positive crepitus was noted, and goniometric ROM measurements showed flexion of 110 degrees (normal 90) and extension of 5 degrees (normal 0), with limitation due to pain.  

At the 23 June 2009 VA Compensation and Pension (C&P) examination, 1 week before separation, the CI reported intermittent aching, and sometimes sharp, knee pain, rated at 5-7/10, and occurring 10 times a day, lasting one minute.  Activity aggravated the pain, but rest relieved it.  Physical examination showed a normal gait and posture, intact neurovascular findings, and normal ROM.  There was no pain, fatigue, weakness, lack of endurance or incoordination after repetitive use.  X-rays demonstrated no significant findings.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the left knee pain 10%, coded analogously as 5003 (degenerative arthritis), citing painful motion.  The VA also rated the left knee pain 10%, dual coded 5261-5003 (limitation of extension of leg–degenerative arthritis), based on the C&P examination, citing painful or limited motion of a major joint or group of minor joints.  Members agreed there was no limitation of flexion or extension which supported a rating under diagnostic codes extension 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 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 left knee condition.  

BOARD FINDINGS:  In the matter of the left patellofemoral syndrome 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.  

AR20190005629, 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.