RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXX	CASE:  PD-2017-05979
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20050731

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E4, Power Generator Equipment Repairer, medically separated for “right knee pain secondary to patellofemoral syndrome” with a disability rating of 10%.   

CI CONTENTION:  The evaluation was not complete and he also requested review of additional 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 - 20050422	VARD - 20060117	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Right Knee Pain Secondary to Patellofemoral Syndrome	5099-5003	10%	Right Knee Patellofemoral Syndrome	5299-5257	10%	20051108	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  40%	

ANALYSIS SUMMARY: 

Right Knee Pain.  According to the service treatment record and MEB narrative summary (NARSUM), the CI injured this right knee in September 2003 after falling during a run.  Knee X-rays were negative, and after a course of physical therapy, profile restrictions and medication, he continued to have pain.  An MRI showed no ligament or meniscal tear.  The 6 January 2005 MEB NARSUM examination, 6 months prior to separation, noted complaints of right knee discomfort, pain and swelling aggravated by any increased activity.  Physical examination showed tenderness over the quadriceps, suprapatellar area, and along the patella.  Range of motion (ROM) was 0-120 degrees (normal 0-140) with positive patellar grind.  

At the 8 November 2005 VA Compensation and Pension (C&P) examination, 4 months after separation, the CI reported bilateral knee pain rated at 6-7/10, as well as weakness, stiffness, swelling, fatigability, redness/warmth, and instability.  Additionally, flare-ups caused functional limitations.  Physical examination showed no obvious redness, warmth or swelling, and patellofemoral testing revealed no knee instability.  Flexion was to 120 degrees, with pain, and extension to 0 degrees, without pain.  Mild fatigue, weakness and lack of endurance was noted with repetitive testing, but without decreased ROM.   

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the right knee condition 10%, analogously coded 5099-5003 (degenerative arthritis) citing the US Army Physical Disability Agency pain policy.  The VA also rated the right knee condition 10%, but analogously coded 5299-5257 (knee, other impairment of), based on the C&P examination, citing slight, recurrent knee subluxation or lateral instability.  Panel members agreed that while there was no limitation of flexion or extension (5260 or 5261) which supported a compensable rating, there was evidence of painful motion with functional loss supporting a 10% rating (based on §4.59, §4.40 and §4.45) as adjudicated by the PEB.  The examinations proximate to separation did not demonstrate the presence of ligamentous instability or laxity (5257); a history of dislocated meniscus or loose body causing frequent locking with recurrent effusions (5258); or fracture, non-union 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, and no grounds for additional rating based on the presence of instability.  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 right knee condition.  

BOARD FINDINGS:  In the matter of the right 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.  

	PD-2017-05979

ARXXXXXXXXXXX, XXXXXXXXXXXXXXXXXX

Dear XXXXXXXXXXXXXX

	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.

Sincerely,					      

Enclosure

	PD-2017-05979