RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXX	CASE:  PD-2014-01093
BRANCH OF SERVICE:  AIR FORCE	sepAration Date: 20081006

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty, E5, Nuclear Weapons Craftsman, medically separated for “right and left knee chondromalacia,” rated 10% and 10% respectively, with a combined rating of 20%.  

CI CONTENTION:  He was not evaluated for hemorrhoids, sinus problems and left heel conditions.  The applicant’s complete submission is at Exhibit A.  

SCOPE OF REVIEW:  The Board’s scope of review is defined in DoDI 6040.44.  It is limited 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 PEB, but determined to be not unfitting.  Any conditions outside the Board’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.  Furthermore, the Board’s authority is limited to assessing the fairness and accuracy of PEB rating determinations and recommending corrections, where appropriate.  The Board’s assessment of the PEB rating determinations is confined to review of medical records and all available evidence for application of the Veterans Affairs Schedule for Rating Disabilities (VASRD) standards to the unfitting medical condition at the time of separation.  The Board 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, operating under a different set of laws.  The Board gives consideration to VA evidence, particularly within 12 months of separation, but only to the extent that it reasonably reflects the severity of the disability at the time of separation.  

RATING COMPARISON:  

SERVICE PEB – Dated 20080820	VARD - 20090612	
Condition	Code	Rating	Condition	Code	Rating
	Exam	
Patellofemoral Chondromalacia, Right Knee	5099-5014	10%	Chondromalacia Patella, Right	5010	10%	20081217	
Patellofemoral Chondromalacia, Left Knee	5099-5014	10%	Chondromalacia Patella, Right	5010	10%	20081217	
COMBINED RATING:  20%	COMBINED RATING OF ALL VA CONDTIONS:  30%	

ANALYSIS SUMMARY:  

Right and Left Knee Chondromalacia Condition.  According to service treatment records and the Medical Evaluation Board narrative summary (NARSUM), the CI’s right and left knee condition began in 2002 without specific injury.  Radiographic studies in March and April 2007 showed possible bone bruising of the left medial femoral condyle (upper aspect of left inner knee joint) and right patellar (kneecap) chondromalacia (inflammation and softening of the cartilage).  There were no abnormalities of ligaments or meniscal cartilage.  Surgical options were considered but reasonably declined by the CI.  

At the NARSUM examination on 5 May 2008 (5 months prior to separation), the CI reported pain beneath kneecaps with running, ascending stairs, sitting for prolonged periods and with deep knee bends.  He also reported knee swelling after running and a feeling of giving out with deep squatting.  The physical exam of the right knee showed no swelling and reasonable patellar tracking.  Tenderness and crepitus were present.  Knee flexion was 135 degrees (normal 140 degrees) and extension was 0 degrees (normal 0 degrees).  While one maneuver suggested possible mild laxity of the anterior and posterior cruciate ligaments (ACL and PCL), two other tests of ACL integrity were normal.  Medial and lateral collateral ligaments were stable.  A test of meniscal injury was negative.  A patellar grind test reproduced the CI’s pain symptoms.  Examination of the left knee noted identical findings as the right, including measurements of flexion and extension.

At the VA Compensation and Pension (C&P) examination on 17 December 2008 (2 months after separation) the CI reported difficulty squatting and difficulty climbing more than one or two flights of stairs.  Pain severity averaged 2-3/10 but could flare up to 4/10.  There was no mention of locking or giving way.  Examination showed a normal gait. There was no swelling, tenderness or crepitus of either knee.  Right knee flexion was 124 degrees and extension was 0 degrees.  Left knee flexion was 118 degrees and extension 0 degrees.  Painful motion was noted when squatting or arising from a squat, and required the CI to use his hands for assistance during these position changes.  Ligaments were intact.  Repetitive motion did not result in additional limitation in range-of-motion or squatting.  

The Board directed attention to its rating recommendation based on the above evidence.  The PEB rated the left and right knee conditions 10% each coded analogously to 5014 (osteomalacia).  The VA likewise rated each knee at 10% under the 5010 code (arthritis due to trauma) citing painful motion noted when squatting during the exam.  Board members considered that the objective findings and associated disability for each knee were identical, and agreed with the PEB and the VA that the respective ratings should therefore be the same.  The Board concluded that there was sufficient evidence of painful motion and functional loss to support a 10% rating for each knee IAW §4.59 and §4.40.  In considering routes to a higher rating however, there was no limitation of motion which attains a minimum rating under the diagnostic codes for limitation of flexion (5260) or extension (5261).  Furthermore, there was no evidence of recurrent subluxation.  Although the NARSUM examiner noted a finding of possible ACL and PCL ligament laxity, other ACL tests by the same examiner were not confirmatory.  Likewise, the C&P examiner’s ligament findings were completely normal, and consistent with radiographic imaging showing intact ligaments.  The Board therefore concluded that there was insufficient evidence to warrant a rating under the 5257 code (knee, other impairment of).  There was also no evidence of dislocated semilunar cartilage with frequent episodes of locking, pain, and effusion into the joint to justify rating under the 5258 code.  The Board thus concluded that there is no VASRD §4.71a route to a rating higher than the 10% for each knee adjudicated by the PEB.  After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the Board concluded that there was insufficient cause to recommend a change in the PEB adjudication for the left and right knee conditions.  

BOARD FINDINGS:  In the matter of the bilateral knee condition and IAW VASRD §4.71a, the Board unanimously recommends no change in the PEB adjudication.  There were no other conditions within the Board’s scope of review for consideration.  The Board, therefore, recommends that there be no re-characterization of the CI’s disability and separation determination.  

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20140220 w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

SAF/MRB
1500 West Perimeter Road, Suite 3700
Joint Base Andrews, MD  20762

Dear XXXXXXXXXXXXXX:

Reference your application submitted under the provisions of DoDI 6040.44 (Section 1554, 10 USC), PDBR Case Number PD-2014-01093.

After careful consideration of your application and treatment records, the Physical Disability Board of Review determined that the rating assigned at the time of final disposition of your disability evaluation system processing was appropriate.  Accordingly, the Board recommended no re-characterization or modification of your separation.

I have carefully reviewed the evidence of record and the recommendation of the Board.  I concur with that finding and their conclusion that re-characterization of your separation is not warranted.  Accordingly, I accept their recommendation that your application be denied.

Sincerely,

Attachment:
Record of Proceedings