RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXXX	CASE:  PD-2014-02877
BRANCH OF SERVICE:  Army	BOARD DATE:  20150623
SEPARATION DATE:  20090519

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E-3 (Petroleum Supply Specialists) medically separated for left knee chondromalacia.  The left knee could not be adequately rehabilitated to meet the physical requirements of his Military Occupational Specialty.  The profile allows for an alternate aerobic event to satisfy physical fitness standards.  He was issued a permanent L3 profile and referred for a Medical Evaluation Board (MEB).  “Left chondromalacia of patella with recurrent symptoms” was forwarded to the Physical Evaluation Board (PEB) IAW AR 40-501.  No other condition was submitted by the MEB.  The Informal PEB adjudicated chondromalacia, left knee 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:  “Please consider all conditions.”

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 20090311	VA* - (~ 13 Mos. Post-Separation)  	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chondromalacia, Left Knee…	5099-5003	10%	Degenerative Disease, Left Knee	5010-5260	10%	20100609	
Other MEB/PEB Conditions x 0 (Not in Scope)	Other x 2 	
RATING:  10%	RATING:  50%	
*Derived from VA Rating Decision (VARD) dated 20100909 (most proximate to date of separation [DOS]).

ANALYSIS SUMMARY:

Chondromalacia, Left Knee Condition.  The narrative summary notes that at enlistment the CI had a history of recurrent left knee patellar dislocation and had undergone surgery in 2003 with good results.  The left knee condition was noted on the military enlistment physical on 25 August 2007; the CI was asymptomatic at the time and after orthopedic consultation he was granted a waiver for left patellar subluxation.  In June 2008 the CI reported pain in the left knee with running.  Knee X-rays were normal and magnetic resonance imaging (MRI) performed on 24 June 2008 noted degenerative changes of the patellar cartilage and a moderate joint effusion.  Orthopedic evaluation on 11 August 2008 noted an effusion with positive patellofemoral testing, but there was no instability or abnormal patellar mobility noted.  Diagnostic arthroscopy was performed on 20 August 2008 with removal of loose bodies (bone/cartilage pieces from damage) from the joint, repair of an area of patellar cartilage injury, and a “lateral release” of the patella (release of tight tissue on the lateral aspect).  Following the surgery the CI continued to have chronic pain, aggravated by activity, and recurrent effusions, but no dislocations or instability, and an MEB was initiated.  Repeat MRI performed on 24 February 2009 performed to evaluate continued knee pain and swelling noted scarring of the lateral patellar area and degenerative changes of the patella, without a significant joint effusion noted.

At the MEB examination performed on 5 February 2009, 3 months prior to separation, the CI reported chronic left knee pain, aggravated by weight bearing activities.  The MEB physical exam noted no effusion or tenderness to palpation (TTP).  Knee range-of-motion (ROM) was extension-flexion of 0 to 130 degrees (normal 0 to 140).  The MEB examiner indicated that “when DeLuca’s consideration was applied, it appeared that there would be a 10 degree decrease in flexion of the knee due to increasing pain.”

At the VA Compensation and Pension General examination on 9 June 2010, 13 months after separation, the CI reported pain stiffness, instability and swelling of the knee.  The exam noted a normal gait with normal strength, sensation, and reflexes of the lower extremity.  There was no TTP, laxity, or swelling of the knee.  There was full ROM, with painful motion noted, and no additional loss of ROM with repetition.  Left knee MRI performed on 14 May 2010 showed a partial tear of the lateral retinaculum (fibrous tissue) of the patella, with local soft tissue swelling and cartilage loss (chondromalacia) in the patellofemoral compartment.

The Board directed attention to its rating recommendation based on the above evidence.  The PEB adjudicated the knee condition as existed prior to service (EPTS), rated 10%, coded as 5099-5003 (analogous to degenerative arthritis), with an undetermined EPTS factor, and the VA rated it 10%, coded 5010-5260 (limited leg flexion with traumatic arthritis).  The Board agreed that the evidence in record supports a 10% rating of the knee condition coded either as 5003 for limited ROM or as 5260 with consideration of functional loss IAW §4.59 (Painful motion), §4.40 (Functional loss) and §4.45 (The joints).  The Board reviewed to see if a higher evaluation was achieved utilizing any other applicable §4.71a code.  There was no evidence in record of recurrent patellar subluxation or lateral joint instability after the surgery in 2008.  There was also no evidence of leg flexion limited to 30 degrees or less or limited leg extension; impairment of the femur, tibia, or fibula; semilunar cartilage injury; or, ankylosis of the knee to support a higher rating.  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 adjudication for the knee 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 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.

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 20140515, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

SAMR-RB	0 6 Jul 2016

MEMORANDUM FOR Commander, US Army Physical Disability Agency (AHRC-00), 2900 Crystal Drive, Suite 300, Arlington, VA  22202-3557

SUBJECT:  Department of Defense Physical Disability Board of Review Recommendation for XXXXXXXXXXXXXXXXXXXX, AR20160003171  (PD201402877)

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 ( ) OVA