RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME: XXXXXXXXXXXXXXXXXX	      CASE:  PD-2015-00236
BRANCH OF SERVICE: Army                                                                   SEPARATION DATE:  20020322 

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E-4, Military Police, medically separated for “chondromalacia patella, left knee…” with a disability rating of 0%.  

CI CONTENTION:  He was given a higher rating for his conditions by the VA.  The CI asserts that he should have been medically retired.  The complete submission is at Exhibit A.  

SCOPE OF REVIEW:  The panel’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 panel’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 panel’s authority is limited to assessing the fairness and accuracy of PEB rating determinations and recommending corrections, where appropriate.  The panel’s assessment of the PEB rating determinations is based on 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 panel 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 panel 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 - 20020219	VARD - 20020729	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chondromalacia Patella, Left Knee…	5299-5003	0%	Chrondromalacia of the Left Knee	5099-5003	10%	20020617	
COMBINED RATING:  0%	COMBINED RATING OF ALL VA CONDITIONS:  30%	

ANALYSIS SUMMARY:   

Left Knee Chondromalacia Patella.  According to the service treatment record (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s chronic history of knee pain commenced with a skiing accident in 1996 and was exacerbated by subsequent injuries.  The CI eventually underwent arthroscopic surgical intervention in May 2001 (10 months before separation).  During surgery, chondromalacia patella (damage to the cartilage under the knee cap) was identified and a chondroplasty was performed.  Both intraoperative findings and magnetic resonance imaging confirmed the absence of any significant meniscal or ligamentous pathology.  Post-operative STR clinical entries confirmed an uncomplicated course with restoration of full range of motion (ROM) and the absence of any ligamental instability or signs of impingement (locking).  There was no specific documentation of painful motion in any post-operative entries. 

The 8 January 2002 NARSUM examination, 6 weeks before separation, documented persistent pain rated “slight and frequent” that limited “prolonged standing, running, marching, walking and jumping.”  The examiner also commented that occasionally the knee would “give out secondary to pain and spasm.”  The physical examination recorded crepitus without tenderness (no effusion noted), 4-plane stability to stress testing, and no signs of impingement.  Measured ROM was flexion to 130 degrees (normal 140) and extension to 0 degrees (normal 0), specifying crepitus (but not pain) with motion.  

A 30 May 2002 VA orthopedic Compensation and Pension (C&P) examination, 2 months after separation, was supplemented by a general C&P examination soon afterwards (17 June).  Both VA examiners documented non-specific pain that limited prolonged standing or walking.  The physical examination recorded a normal gait, the absence of tenderness, stability to stress testing in all planes, and no signs of impingement.  The orthopedic examiner failed to provide ROM measurements, although the general examiner documented that ROM was grossly normal.  Neither examiner documented the presence of painful motion.

The panel directed attention to its rating recommendation based on the above evidence.  The PEB’s 0% rating under code 5099-5003 (analogous to degenerative arthritis) did not cite a rationale.  The VA’s 10% rating under the same code cited “complaints of pain” without invoking painful motion.  There was no ROM limitation, persistent effusion and locking, or fracture with non-union or malunion to support the minimum 10% rating under any applicable code; and, there was no evidence for (or PEB stipulation of) of joint instability for separate rating.  Members agreed that there was not satisfactory evidence of painful motion to support a 10% rating IAW VASRD §4.59.   After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the panel concluded that there was insufficient cause to recommend a change in the PEB adjudication of the left knee condition.

PANEL FINDINGS:  In the matter of the left knee condition and IAW VASRD §4.71a, the panel unanimously recommends no change in the PEB adjudication.  There were no other conditions within the panel’s scope of review for consideration.  The panel, 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 20150331, 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

10 Apr 2017

SUBJECT:  Department of Defense Physical Disability Board of Review Recommendation for 
XXXXXXXXXXXXXXXXXX, AR20170004751 (PD-2015-00236)

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