RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXX	CASE:  PD1300127
BRANCH OF SERVICE:  Army	BOARD DATE:  20130827
SEPARATION DATE:  20061124

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty PV1/E-1 (21B00/Combat Engineer) medically separated for right knee condition.  On 21 March 2006, the CI fell while participating in land navigation training and had immediate onset of right knee pain, which could not be adequately rehabilitated to meet the physical requirements of his Military Occupational Specialty or satisfy physical fitness standards.  He was issued a permanent L3 and referred for a Medical Evaluation Board (MEB).  The right knee condition, characterized as right knee pain was forwarded to the Physical Evaluation Board (PEB) IAW AR 40-501.  No other conditions were submitted by the MEB.  The PEB adjudicated patellofemoral pain syndrome (PFPS), right knee as unfitting, rated 0% with likely application of the US Army Physical Disability Agency (USAPDA) pain policy.  The CI made no appeals and was medically separated.

CI CONTENTION:  VA found me originally 20% for the reasoning as to why I was discharged.   My condition has now caused a neurological disability (non-curable) called Complex Regional Pain Syndrome.  I am Now 40% disabled due to my condition. 

SCOPE OF REVIEW: The Board’s scope of review is defined in DoDI 6040.44, Enclosure 3, paragraph 5.e.(2).  It is limited to those conditions determined by the PEB to be unfitting for continued military service and those conditions identified but not determined to be unfitting by the PEB when specifically requested by the CI.  The rating for the unfitting right knee condition is addressed below; and, no additional conditions are within the DoDI 6040.44 defined purview of the Board.  Any conditions or contention not requested in this application, or otherwise outside the Board’s defined scope of review, remain eligible for future consideration by the Board for Correction of Military Records.

RATING COMPARISON:

Service IPEB – Dated 20061107	VA - (~2 Mos. Post-Separation)  	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Patellofemoral Pain Syndrome, Right Knee	5099-5003	0%	Residuals, Right Knee Injury	5014-5260	10%*	20070127	
No Additional MEB/PEB Entries	 	20070127	
Rating:  0%	Combined Rating:  20%	
Derived from VA Rating Decision (VARD) dated 20060305 (most proximate to date of separation [DOS]).   

ANALYSIS SUMMARY:

Patellofemoral Pain Syndrome, Right Knee Condition.  The CI’s history of right knee pain was associated with a reported fall he sustained in April 2006 during advanced individual training.  During an emergency room visit on 12 July 2006, the CI reported sensation of right knee giving out and popping.  Physical examination (PE) recorded right knee pain and a restricted range-of-motion (ROM) accompanied by pain.  Magnetic resonance imaging (MRI) of the right knee obtained in July 2006 documented findings of suggestive a mild medial collateral ligament sprain.  Physical therapy (PT) note on 16 August 2006 recorded a normal gait and a normal right knee examination.  Examination of the right knee on 19 August 2006 revealed right knee with full ROM but painful.  PT evaluation on 5 September 2006, approximately 2 months prior to separation, noted right knee tenderness on palpation with pain elicited by motion.  The knee demonstrated full ROM and tests for knee instability were negative.  The CI’s profile allowed no running, but could walk, bike and swim at his own pace and distance.  At the MEB narrative summary evaluation on 18 September 2006, 2 months prior to separation, the CI reported continued knee pain with activity and ambulation.  On PE, ROM was normal bilaterally with no evidence of knee instability.  There was tenderness to palpation over the medial collateral ligament in the right knee, with a small amount of medial joint line tenderness.  At the VA Compensation and Pension evaluation on 27 January 2007, 2 months after separation, the CI indicated he was working full-time (as an instructor at a children’s boot camp) and continued to experience right knee pain accompanied by sensation of knee instability.  PE revealed no evidence of patellar abnormality, no knee locking or crepitation and no evidence of knee instability.  Tenderness and guarding were noted during palpation and movement of the right knee.  The examiner recorded a slightly reduced flexion of 110 degrees and a further reduction to 96 degrees upon repetition, secondary to pain.  MRI of right knee on 7 January 2007 demonstrated degenerative changes of the medial meniscus but no evidence of a tear.

The Board directs attention to its rating recommendation based on the above evidence.  The PEB rated the right knee pain condition at 0% analogous to degenerative arthritis code of 5099-5003 citing pain as slight and occasional.  The VA rated the condition at 10% code 5014-5260 based on painful limitation of flexion/motion.  A higher rating of 20% under this code requires limitation of flexion of 35 degrees not supported by the record in evidence.  The Board agreed the evidence supported the application of VASRD §4.59 (compensable rating for painful motion).   On review of the records, the Board noted that even though the flexion was reduced it was not compensable under codes 5260 or 5261.  The Board considered the 5258 code; however, there were no objective evidence of frequent episodes of locking and effusions to support the use of this code.  No VASRD sanctioned pathway to a rating higher than the minimal compensable rating was found.  After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the Board recommends a disability rating of 10% for the right knee pain condition.

BOARD FINDINGS:  IAW DoDI 6040.44, provisions of DoD or Military Department regulations or guidelines relied upon by the PEB will not be considered by the Board to the extent they were inconsistent with the VASRD in effect at the time of the adjudication.  As discussed above, PEB reliance on the USAPDA pain policy DoDI 1332.39 for rating the right knee condition was operant in this case and the condition was adjudicated independently of that policy by the Board.  In the matter of the right knee condition, the Board by a 2:1 vote, recommends a disability rating of 10%, coded 5099-5003 IAW VASRD §4.71a.  The single voter for dissent, who recommended no recharacterization at 0%, elected not to submit a minority opinion.  There were no other conditions within the Board’s scope of review for consideration.

RECOMMENDATION:  The Board recommends that the CI’s prior determination be modified as follows, effective as of the date of his prior medical separation:  

UNFITTING CONDITION	VASRD CODE	RATING	
Patellofemoral Pain Syndrome, Right Knee	5099-5003	10%	
COMBINED	10%	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20130314, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans’ Affairs Treatment Record

XXXXXXXXXXXXXX, DAF
President
Physical Disability Board of Review
SFMR-RB									

MEMORANDUM FOR Commander, US Army Physical Disability Agency 
(AHRC-DO), 2900 Crystal Drive, Suite 300, Arlington, VA  22202-3557

SUBJECT:  Department of Defense Physical Disability Board of Review Recommendation 
for xxxxxxxxxxxxxxxxxxxxxxxxx, AR20130021882 (PD201300127)

1.  I have reviewed the enclosed Department of Defense Physical Disability Board of Review (DoD PDBR) recommendation and record of proceedings pertaining to the subject individual.  Under the authority of Title 10, United States Code, section 1554a,   I accept the Board’s recommendation to modify the individual’s disability rating to 10% without recharacterization of the individual’s separation.  This decision is final.  

2.  I direct that all the Department of the Army records of the individual concerned be corrected accordingly no later than 120 days from the date of this memorandum.   

3.  I request that a copy of the corrections and any related correspondence be provided to the individual concerned, counsel (if any), any Members of Congress who have shown interest, and to the Army Review Boards Agency with a copy of this memorandum without enclosures.

BY ORDER OF THE SECRETARY OF THE ARMY:

Encl						     xxxxxxxxxxxxxxxxxxxxx
						     Deputy Assistant Secretary
						         (Army Review Boards)