RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	     CASE:  PD-2014-01132
BRANCH OF SERVICE:  Army 	sEPARATION DATE:  20091117

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E-4 (Human Resources Specialist) medically separated for left knee pain.  The condition could not be adequately rehabilitated to meet the physical requirements of his Military Occupational Specialty (MOS).  He was issued a permanent L3 profile and referred for a Medical Evaluation Board (MEB).  The “chondromalacia” was forwarded to the Physical Evaluation Board (PEB) IAW AR 40-501.  The MEB also identified and forwarded five other conditions (back pain; headaches; adjustment disorder; alcohol dependence; and epididymal cyst) for PEB adjudication.  The Informal PEB adjudicated the left knee pain condition as unfitting, rated 10%.  The PEB determined alcohol dependence was a condition not constituting a physical disability and the remaining conditions were determined to be not unfitting.  The CI made no appeals and was medically separated.   

CI CONTENTION:  His knee condition continues to worsen and negatively impacts his daily activities.  Also, although listed in the wrong section of the application, it is assumed he also contends back pain, headache, and adjustment disorder, as he listed these conditions.  His complete submission is at Exhibit A.

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 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/Naval 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 Veteran’s 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:    

IPEB - Dated 20090805	VA* - (~6 Mos. Pre-Separation)	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chondromalacia Patella Left Knee…	5299-5014	10%	Chondromalacia Patella Left Knee and Residual Scar	5299-5014	10%	20090529	
Lower Back Pain	Not Unfitting	Muscle Strain Lower Back	5242	10%	20090529	
Stress Headaches		Headache Syndrome	8199-8100	0%	20090529	
Adjustment Disorder with Depressed Mood (in Remission)		Adjustment D/O …	9440	10%	20090616	
Other MEB/PEB Conditions x 5 (Not In Scope)	Other x 3 	
RATING:  10%	RATING:  30%	
*Derived from VA Rating Decision (VARD) dated 20091120 (most proximate to date of separation (DOS)).  

ANALYSIS SUMMARY:  

Chondromalacia Patella, Left Knee.  The CI first presented for an 18-month history of left knee pain on 19 September 2008, 6 months after separation, reporting that it was aggravated by activity.  An MRI on 30 September 2008 showed a medical meniscus (a cartilage cushion in the knee) tear (MMT) in the posterior horn and body.  This was repaired surgically on 30 October 2008.  Degeneration of the joint cartilage was an incidental finding.  The knee was stable and the other meniscus was normal.  He underwent rehabilitation in physical therapy, but his pain persisted although it was improved.  He was then referred for MEB.  At the MEB examination on 1 March 2009, 9 months prior to separation, the CI reported only the history of knee surgery.  The examiner noted that the CI had crepitus (an abnormal sensation or sound with pressure or movement of the joint) with range-of-motion (ROM).  The VA Compensation and Pension (C&P) examination was performed on 29 May 2009, 6 months before separation.  The CI reported the onset of left knee pain after a 6-mile run followed by sprints.  Despite surgery and rehabilitation, he reported ongoing pain.  On examination, his gait was normal and the ROM near normal.  The knee was stable and signs of meniscal irritation were absent.  Crepitus was present.  The narrative summary (NARSUM) was dated 29 June 2009, four months prior to separation.  The CI reported an acute onset of left knee pain while running (contemporaneous records indicate that the knee pain preceded accession by 12 months).  He noted pain with movement and a limitation in activity.  An examination done one month earlier on 29 May 2009, 5 months prior to separation, note pain with compression and rotation of the kneecap and crepitus.  The knee was stable.  Signs of meniscal irritation were not recorded.  Atrophy was absent, but tone was reduced on the left.  He was thought to fail retention standards due to chondromalacia patella (CMP, a degeneration of the cartilage of the kneecap).  The goniometric ROM evaluations in evidence which the Board weighed in arriving at its rating recommendation, with documentation of additional ratable criteria, are summarized in the chart below.

Left Knee ROM
(Degrees)	PT ~7 Mo. Pre-Sep	VA C&P ~6 Mo. Pre-Sep	
Flexion (140 Normal)	140 (141)	135	
Extension (0 Normal)	0	0	
Comment	Limited by pain	Painful motion	
§4.71a Rating	10%	10%	

The Board directed its attention to its rating recommendation based on the above evidence.  Both the PEB and VA rated the knee at 10%, coded 5299-5014 (analogous to osteomalacia).  The Board considered the evidence and found no route to a higher rating.  The Board also considered the surgical scar and found no evidence that this interfered with duty.  The Board concluded therefore that this condition was not unfitting and could not be recommended for additional disability rating.  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 knee condition.  

Contended PEB Conditions.  The CI did not contend for the back pain, headache, and adjustment disorder in the correct location on the application, but review of the contention indicates that the CI wished these conditions to be considered as well.  The Board’s main charge is to assess the fairness of the PEB’s determination that these were not unfitting.  The Board’s threshold for countering fitness determinations requires a preponderance of evidence, but remains adherent to the DoDI 6040.44 “fair and equitable” standard.  None was profiled or implicated in the commander’s statement.  All were judged to meet retention standards.  All were reviewed and considered by the Board.  There was no performance based evidence from the record that any of these conditions significantly interfered with satisfactory duty performance at the time of separation.  After due deliberation in consideration of the preponderance of the evidence, the Board concluded that there was insufficient cause to recommend a change in the PEB fitness determination for the any of contended conditions and so no additional disability ratings are recommended. 

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.  The Board did not surmise from the record or PEB ruling in this case that any prerogatives outside the VASRD were exercised.  In the matter of the left knee chondromalacia condition and IAW VASRD §4.71a, the Board unanimously recommends no change in the PEB adjudication.  In the matter of the contended lower back pain, stress headaches, and adjustment disorder conditions, the Board unanimously recommends no change from the PEB determinations as not unfitting.  There were no other conditions within the Board’s scope of review for consideration.  

RECOMMENDATION:  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 20140227, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

SAMR-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 XXXXXXXXXXXXXXXXXX, AR20160003618 (PD201401132)

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 and hereby deny the individual’s application.  
This decision is final.  The individual concerned, counsel (if any), and any Members of Congress who have shown interest in this application have been notified of this decision by mail.

 BY ORDER OF THE SECRETARY OF THE ARMY:

Enclosure

CF: 
(  ) DoD PDBR
(  ) DVA