RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2014-04239
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20030124

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E4, Motor Transport Operator, medically separated for “chondromalacia of right knee,” with a disability rating of 10%.

CI CONTENTION:  “Because my injury is worse than when I got out.  I can’t even extend my leg out fully.  I really believe my % should be higher.”  The CI’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 based upon a 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 - 20021030	VARD - 20030806	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chondromalacia of the Right Knee	5099-5003	10%	Right Knee Medial Lateral Meniscus Tear and Arthritis	5260-5010	10%	20030501	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  10%	

ANALYSIS SUMMARY:  

Chondromalacia of Right Knee.  The service treatment records (STRs) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI underwent right knee arthroscopy surgery in July 2002 for a lateral meniscus tear and a concomitant injury to his left lateral femoral condyle and lateral tibial plateau.  Following surgery further treatment did not result in improvement sufficient to allow unrestricted duty.  The MEB forwarded “chondromalacia of right knee” for PEB adjudication.

At the MEB examination (recorded on DD Forms 2807 and 2808) dated 4 October 2002, 3 months prior to separation, the CI reported he tore his lateral meniscus and had arthroscopic surgery to “fix my meniscus.”  The examiner noted scars of the right knee.  

The MEB physical examination noted a range of motion (ROM) of a normal extension of 0 degrees and a flexion of 125 degrees (normal 140).  The CI had a minimal to moderate effusion with tenderness to palpation about the lateral femoral condyle and no tenderness to palpation about the patella (kneecap) or proximal tibia.  There was no varus or valgus instability and negative Lachman and pivot shift tests for instability; however, the CI had an antalgic gait.  Sensation was normal throughout, but the CI was unable to squat secondary to pain.  As a result of the chondromalacia of the right knee, the CI was unable to run or perform any impact activities.

At the 1 May 2003 VA Compensation and Pension (C&P) examination, performed 4 months after separation, the CI reported right knee pain as throbbing in nature mostly over the lateral joint line with swelling, catching, locking and “giving way.”  He could not stand for greater than an hour or do any physical activity due to knee pain.  The CI did not use a brace or cane or take medications and he described the pain as a constant 8/10, but the pain did not impact his activities of daily living.  On examination, his right knee ROM showed a normal extension and a flexion of 120 degrees.  Scars from the arthroscopy portals were present.  He had tenderness to palpation over the lateral joint line and his knee was stable to varus and valgus testing and his ACL (anterior cruciate ligament) and PCL (posterior cruciate ligament) were intact; however, the CI did have a positive McMurray’s test (to determine a meniscal tear) and a 2+ effusion was present.  Radiographic studies showed right knee degenerative joint disease.   

The Board directed attention to its rating recommendation based on the above evidence.  The PEB rated the right knee condition 10%, analogously coded 5099-5003 (arthritis, degenerative), citing the US Army Physical Disability Agency (USAPDA) pain policy, pain rated as slight and constant. The VA rated the right knee condition 10% coded 5260-5010 (leg, limitation of flexion-arthritis), citing medial lateral meniscal tear and arthritis.  There was no limitation of motion which supported a rating under the diagnostic codes for limitation of flexion or extension (5260, 5261).  The persistence of pain after meniscal surgery warranted a 10% rating under the 5259 code (cartilage, semilunar, removal of symptomatic), albeit the PEB used code 5099-5003 IAW with USAPDA policy.  The examinations proximate to separation did not demonstrate the presence of ligamentous instability or laxity (5257), and there was no history of dislocated meniscus or loose body causing frequent locking with recurrent effusions (5258), to support a rating under the respective codes; however, the CI reported locking at the VA C&P examination only, albeit the frequency was not reported nor was it objectively demonstrated.  

While the CI did have objective findings of effusions and reported pain, Board members agreed that the condition did not rise to a 20% rating using code 5258 because of the lack of documented frequency of locking and swelling in the record.  Furthermore, there was no fracture, non-union, or malunion of the femur or tibia to support consideration under the respective codes for knee impairment related to long bone conditions (5255, 5262).  Therefore, there was no VASRD §4.71a route to a rating higher than the 10% adjudicated by the PEB under any applicable code, and no grounds for additional rating based on the presence of instability.  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 chondromalacia of the right knee condition.  

BOARD FINDINGS:  In the matter of the chondromalacia of the right 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 20141026, w/attachments
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

08 DEC 2016

SUBJECT:  Department of Defense Physical Disability Board of Review Recommendation for 
XXXXXXXXXXXXXXXXXX, AR20160018302 (PD201404239)

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