RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXXX	CASE:  PD-2014-01378
BRANCH OF SERVICE:  Army  	SEPARATION DATE:  20070619

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E-5 (Avionic Communications Equipment Repairer) medically separated for right knee pain.  The condition could not be adequately rehabilitated to meet the physical requirements of his Military Occupational Specialty (MOS) or satisfy physical fitness standards.  He was issued a permanent L3 profile and referred for a Medical Evaluation Board (MEB).  The condition of “severe chondromalacia of the right patella,” was forwarded to the Physical Evaluation Board (PEB) IAW AR 40-501.  No other condition was submitted by the MEB.  The Informal PEB adjudicated his right knee pain as unfitting, rated 10%, citing application of the Veterans Affairs Schedule for Rating Disabilities (VASRD).  The CI made no appeals and was medically separated.  

CI CONTENTION:  The applicant contends his “rating was inaccurate and unfair,” which is addressed in the “Scope of Review” below.  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 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 20070306	VA* - (~2 Mos. Pre-Separation)	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chondromalacia, Right Patella…	5099-5003	0%	Right Knee Chondromalacia Patella	5014-5260	0%**	20070409	
Other x 0 (Not In Scope)	Other x 5	
RATING:  0%	RATING:  0%	
*Derived from VA Rating Decision (VARD) dated 20070614 (most proximate to date of separation [DOS]).  VARD 20120417 awarded 10% rating effective date after separation from Board of Veteran’s Appeal (BVA).

ANALYSIS SUMMARY:  

Right Knee Condition.  According to service treatment records and the MEB narrative summary (NARSUM); the CI’s right knee condition began in 2004 associated with a hard parachute landing.  The right knee pain and swelling after activities persisted despite conservative therapy.  Radiographic studies showed normal x-rays with an MRI documenting severe chondromalacia patella.  There was motion on the MRI and possible other abnormalities, including tear of the anterior cruciate ligament and meniscal abnormalities.  Surgery was considered, but never performed.  At the MEB exam, the CI reported continued knee pain with up to 10/10 with swelling after running of activities.  The knee would “quiet down” after 2 days and the CI was on profile restrictions.  There were no symptoms of locking of giving way.  The MEB physical exam noted a normal gait with slight decreased definition of the right thigh muscle and right thigh circumference of 47cm versus 48cm on the opposite thigh.  There was no effusion and no evidence of ligament laxity or meniscal findings.  On examination the right knee range-of-motion (ROM) following repetitive movement were flexion 125 degrees (normal 140) and extension 0 degrees (normal 0).  The NARSUM noted crepitus with pain on motion and the source physical therapy evaluation indicated ROM limitation was due to pain.  Crepitus with motion was noted as was patellofemoral crepitus.  There was no ligamentous laxity and tests for meniscus pathology were negative.  

At the VA Compensation and Pension (C&P) exam, performed 2 months before separation, the CI reported pain, weakness, stiffness, swelling, redness, lack of endurance, and fatigability of the right knee.  On examination of the knee, there was no, tenderness, swelling, effusion, crepitus, limitation of motion, painful motion, ligamentous instability or signs of meniscus (semi-lunar cartilage) pathology or impingement.  Gait and posture were normal and lower extremity strength, reflex and sensory testing was normal.  Radiograph of the right knee was normal.  In the remarks/summary area, the examiner indicated right knee tenderness.  VA records indicate the CI was re-evaluated for complaints of chronic knee pain without intervening trauma, and an MRI dated 28 July 2008 demonstrated an effusion with a medial meniscal tear.  

The Board directed attention to its rating recommendation based on the above evidence.  The PEB rated the right knee condition 0% using analogous 5099-5003 coding (arthritis, degenerative) citing essentially bilaterally equal knee ROMs with a normal gait and only one joint involved.  The VA rated the right knee condition 0% using analogous 5014-5260 coding (osteomalacia-leg, limitation of flexion) with remote Board of Veteran’s Appeal’s and VARD rating the right knee condition at 10% effective the day after separation.  There was no limitation of motion which attains a minimum rating under the diagnostic codes for limitation of flexion or extension, and neither the Service nor VA evidence indicated the presence of ligamentous instability or laxity, or frequent locking with effusions (or any indication of dislocated meniscus or loose body).  However, there was evidence of painful motion with functional loss supporting a 10% rating (based on §4.59, §4.40 and §4.45).  After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt) and §4.59 (painful motion), the Board recommends a disability rating of 10% for the right knee condition, coded 5099-5003.  

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 right knee condition, the Board unanimously recommends a disability rating of 10%, coded 5099-5003 IAW VASRD §4.71a.  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:  

CONDITION	VASRD CODE	RATING	
Chondromalacia, Right Patella…	5099-5003	10%	
COMBINED	10%	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20140318, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

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 XXXXXXXXXXXXXXXXXXXX, AR20160003999 (PD201401378)

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, accept the Board’s recommendation to modify the individual’s disability rating to 10% without re-characterization 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:

CF: 
(  ) DoD PDBR
(  ) DVA