RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2015-00379
BRANCH OF SERVICE:  Army	SEPARATION DATE:  20040415

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E4, Petroleum Supply Specialist, medically separated for “chronic pain, right knee, with patellar instability and chondromalacia” with a disability rating of 10%.

CI CONTENTION:  “Review all conditions.”  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 confined to 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 - 20030128	VARD - 20040218	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Pain, Right Knee	5099-5003	10%	Right Knee Chondromalacia	5261	10%	20040207	
RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  20%	

ANALYSIS SUMMARY:

Chronic Pain, Right Knee.  According to service treatment records and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI first suffered right knee pain with running in late 1999.  The pain persisted and diagnostic imaging (MRI) revealed patellar tendinopathy, but reported intact ligaments and menisci.  Surgery (arthroscopic patellar tendon debridement) ensued in December 2000; and, chondromalacia (damaged joint cartilage) was reported at that procedure.  Subsequently the CI developed patellar instability and in January 2002 (2+ years before separation) he underwent a second surgery (open patellar realignment).  There was a re-injury with patellar dislocation in August 2002.  A repeat MRI was read as normal, and all ligaments and menisci were again reported as intact.  There was ample STR outpatient entries of normal or near normal range of motion (ROM), but painful motion was specified by multiple examiners.  The only exception was during a period after the re-injury with recorded flexion in the range of 70 to 80 degrees (normal 140, minimum compensable 45).  All notations of extension in the STR were normal (0 degrees), and there was no STR evidence for any greater ROM limitation.  There was ample STR documentation of the absence of persistent effusion, stability to stress testing, and negative signs of impingement.  Additional surgery was not indicated and continued conservative treatment did not result in sufficient improvement to allow unrestricted duty.  The MEB forwarded “right knee patellar instability and chondromalacia” for PEB adjudication.

The MEB NARSUM examination in December 2002 (5 months before separation) documented persistent pain rated “slight and constant” interfering with squatting, kneeling, climbing, lifting and carrying.  The physical examination recorded tenderness, no effusion, patellar laxity and apprehension and stable to ligament stress testing.  Measured ROM was flexion to 130 degrees and extension 0 degrees.

A VA Compensation and Pension (C&P) examination in February 2004 (10 months after separation) documented daily flares of knee pain rated 6/10 precipitated by “weight-bearing activities.”  The physical examination recorded a normal gait (frequent use of brace by history), tenderness, “minimal” effusion, and joint instability/laxity (2 millimeter) with ligament stress testing (Lachman and anterior drawer).  Patellofemoral joint tenderness was noted, but no patellar laxity or apprehension.  The ROM measurements were normal, but noted pain with repetition.

The Board directed attention to its rating recommendation based on the above evidence.  The PEB’s rated the right knee pain condition 10%, analogously coded 5099-5003 (degenerative arthritis), citing the U. S. Army Physical Disability Agency (USAPDA) pain policy.  The VA rated the right knee pain condition 10%, coded 5261 (leg, limitation of extension) based on the VA C&P examination 10 months after separation, indirectly citing painful motion.

Members agreed that painful motion was adequately documented and reasonably supports a 10% rating IAW §4.59 (painful motion) and/or §4.40 (functional loss).  There was no persistent effusion and locking, or fracture with non-union or malunion, to achieve a rating higher than 10% under any alternate code.  The Board also considered a dual rating option noting the CI’s intermittent patellar instability with code 5257 (knee, other impairment); however, the Board determined the instability did not interfered with the CI’s satisfactory duty performance at separation.  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 right knee condition.

BOARD FINDINGS:  In the matter of the chronic pain, 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 20150601, 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

19 DEC 2016

SUBJECT:  Department of Defense Physical Disability Board of Review Recommendation for 
XXXXXXXXXXXXXXXXXX, AR20160018707 (PD201500379)

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