RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	    CASE:  PD-2014-01179
BRANCH OF SERVICE:  Army	SEPARATION DATE:  20090601

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E-4 (Petroleum Supply Specialist) medically separated for bilateral 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).  “Chronic bilateral chondromalacia of the patella” (CMP) was forwarded to the Physical Evaluation Board (PEB) IAW AR 40-501.  No other condition was submitted by the MEB.  The Informal PEB adjudicated “chronic bilateral chondromalacia of the patella” as unfitting, rated 20%, citing application of the Veterans Affairs Schedule for Rating Disabilities (VASRD).  The CI made no appeals and was medically separated.  

CI CONTENTION:  His condition continues to worsen and negatively impacts his daily activities.  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 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 20090410	VA* -  based on Service Treatment Records (STR)	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Bilateral CMP	5099-5003	20%	CMP of the Right Knee	5260	0%	STR	
			CMP of the Left Knee	5260	0%		
Other MEB/PEB Conditions x 0 (Not In Scope)	Other x 2	
RATING:  20%	RATING:  10%	
*Derived from VA Rating Decision (VARD) dated 20100322 (most proximate to date of separation [DOS]).  

ANALYSIS SUMMARY:  

Chronic Bilateral Chondromalacia of the Patella.  The record shows that the CI was first seen for right knee pain on 19 September 2006, reporting pain since exposure to an IED (improvised explosive device) 7 months previously.  He was treated with medications and activity restrictions.  X-rays were normal.  He was then seen for left knee pain on 6 June 2007 and thought to have patello femoral pain (syndrome) (PFPS).  He was seen periodically for both knees over the next few years and treated with medications, duty restrictions, and physical therapy (PT).  X-rays of the left knee were normal on 17 March 2008.  X-rays of the right knee were normal on 9 April 2008 and MRIs of the right and left knee were normal on 19 August 2008.  He was seen in orthopedics on 9 October 2008 and noted to have bilateral chondromalacia patella (CMP, a degeneration of the cartilage of the kneecap).  He was not a surgical candidate and had not responded to PT.  MEB was recommended.  At the MEB examination on 23 January 2009, 4 months prior to separation, the CI reported constant knee pain.  The MEB physical examiner noted a mild effusion bilaterally and one of the quadriceps muscles was weak.  The knee was stable and without signs of meniscal (cartilage cushions inside the knees) irritation.  Movement of the kneecaps was normal.  The narrative summary (NARSUM) was dated 30 January 2009.  The CI reported that he could only stand for 10 minutes before he needed to sit due to pain, but then had pain from sitting and needed to stand.  However, he could do the physical fitness walk.  He reported constant grinding and popping noise in his knees.  The examiner referred to the physical examination above (23 January 2009) for the objective findings.  The CI failed to attend his scheduled VA Compensation and Pension (C&P) examination scheduled for 10 February 2010.  The goniometric range-of-motion (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.  

Knee ROM
(Degrees)	PT ~9 Mo. Pre-Sep	MEB ~3 Mo. Pre-Sep	PT ~4 Mo. Pre-Sep	
	Left	Right	Left	Right	Left	Right	
Flexion (140 Normal)	“WNL”	“Decreased by 20”	130	130	94/95/95	85/88/90	
Extension (0 Normal)		--	0	0	0/0/0	0/0/0	
Comment	Painful Motion	Painful motion not documented	Limited by pain; however, able to sit in a chair with his knees bent 90 degrees without discomfort	
§4.71a Rating	10%	10%	0%	0%	10%	10%	

The Board directed attention to its rating recommendation based on the above evidence.  The PEB rated each knee at 10%, coded 5099-5003 (analogous to degenerative arthritis).  The VA initially rated the CI at 0% for each knee, coded 5260 (limitation in flexion), as he did not report for his C&P examination.  The rating for each knee was subsequently raised to 10%, effective 21 October 2013, retaining the 5260 code.  The Board considered the findings.  The ROM was not compensable and instability was absent.  Painful motion was documented supporting a 10% rating.  The Board found no route to a higher rating than the 10% adjudicated for each knee 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 bilateral CMP 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.  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 chronic bilateral CMP 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.  

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 20140218, 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, AR20160003650 (PD201401179)

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