RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXX X 	CASE:  PD-2017-05577
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20061012

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E5, Military Police, medically separated for “right patellar femoral pain syndrome” with a disability rating of 0%.  

CI CONTENTION:  Review of all conditions requested.   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 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 - 20060703	VARD - NA	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Right Patellar Femoral Pain Syndrome	5099-5003	0%	No VA Examination in Evidence	
Chronic Right Shoulder Pain	Not Unfitting		
Depression	Not Unfitting		
COMBINED RATING:  0%	COMBINED RATING OF ALL VA CONDITIONS:  NA	

ANALYSIS SUMMARY:  

Right Patellar Femoral Pain Syndrome.  According to the service treatment record and MEB narrative summary (NARSUM), the CI’s right knee condition began in July 2004 after running.  X-rays performed in August 2004 were normal.  The 31 August 2005 orthopedic clinic physical examination showed patella crepitus and tenderness of the patellar tendon.  There was no effusion, erythema or warmth.  He had no knee deformity, nor medial instability lateral instability.  No anterior or posterior drawer signs were present.  Lachman testing did not demonstrate one plane anterior instability and McMurray testing was negative.  His knee showed full range of motion (ROM) and no pain was elicited by motion.  Right knee X-rays in August 2005 were normal and showed no acute or chronic boney abnormalities.  At the 7 April 2006 primary care clinic appointment, 6 months prior to separation, the CI reported continued pain.  The examiner noted right knee physical examination was within normal limits.  There was no crepitus, ligamentous laxity, focal tenderness, edema, erythema, effusion or limited ROM.  His balance, gait and stance were normal.  During the 4 May 2006 MEB examination (recorded on DD Forms 2807-1 and 2808), 6 months prior to separation, the physical examination showed right patellar crepitus and tenderness over the right patella.  

The 4 May 2006 MEB NARSUM examination, 5 months prior to separation, noted complaints of pain exacerbated by running or by standing or walking for prolonged periods.  Physical examination showed tenderness over the right patellar tendon and the right knee demonstrated crepitus, but no there were no effusions, erythema, warmth, or deformities.  The knee was stable medially and laterally and demonstrated no anterior or posterior drawer sign. The Lachman and McMurray's tests were normal.  The examiner recorded right knee ROM measurements as flexion of 120 degrees (normal 140) and extension of 0 degrees (normal) after multiple repetitions.  There was mild pain in the right knee during ROM measurements.  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 right knee condition 0%, analogously coded 5003 (degenerative arthritis), citing the US Army Physical Disability Agency pain policy. The panel considered multiple VASRD knee and analogous codes, but these were less applicable and/or not advantageous for rating. However, the panel noted 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 right knee condition, coded 5099-5003.  

Contended PEB Conditions:  Chronic Right Shoulder Pain and Depression.  The panel’s main charge is to assess the fairness of the PEB determination that the contended conditions were not unfitting.  The CI’s depression was not profiled or implicated in the commander’s statement, and did not fail retention standards.  The right shoulder condition was profiled with a designator of “2” which indicated that he may require some activity limitations; however, the right shoulder did not fail retention standards and the CI had full ROM and normal strength.  There was no performance-based evidence from the record that either of the conditions significantly interfered with satisfactory duty performance at separation.  After due deliberation, the panel concluded there was insufficient cause to recommend a change in the PEB fitness determination for either of the contended conditions, so no additional disability ratings are recommended.  

BOARD FINDINGS:  In the matter of the right knee patellar femoral pain syndrome, the panel recommends a disability rating of 10%, coded 5099-5003 IAW VASRD §4.71a.  In the matter of the contended right shoulder pain and depression, the panel recommends no change from the PEB determination as not unfitting.  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 Patellar Femoral Pain Syndrome	5099-5003	10%	

AR20200004284, 

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.