RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2015-00662
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20071122

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E3, Trainee, medically separated for “right knee chondromalacia…” with a disability rating of 0%.

CI CONTENTION:  The unfitting knee condition continues to worsen.  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 - 20071026	VARD - 20081004	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Right Knee Chondromalacia…	5099-5003	0%	Right Knee Chondromalacia	5099-5257	0%	STR	
COMBINED RATING:  0%	COMBINED RATING OF ALL VA CONDITIONS:  0%	

ANALYSIS SUMMARY:  

Right Knee Condition.  According to service treatment records (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), on 10 January 2007, the CI fell while running and struck the medial aspect of his right knee.  A 26 January 2007 right knee diagnostic imaging (MRI) study showed a medial meniscal tear.  On 13 April 2007, the CI underwent right knee medial meniscal debridement and patella osteochondral (bone and cartilage) defect debridement.  At the 23 July 2007 orthopedic surgery follow-up, the CI stated “… he was getting back to training until about 2 weeks ago when he was running and felt a pop in his right knee.  He has been having pain and inability to continue running since that time.”  A 2 August 2007 right knee MRI showed an abnormal signal in the posterior horn of the medial meniscus consistent with a tear.  The 17 August 2007 orthopedic surgery follow-up documented “Patient had 3 surgeries on his knee and does not desire to have more. … and when presented with his options he opted for a medical board.”  On 20 August 2007, physical therapy (PT) measured range of motion (ROM) for the MEB.  Goniometer measured right knee active ROM was flexion of 125 (140 normal) and extension of 0 (0) degrees.  At the 17 September 2007 MEB NARSUM examination, 2 months before separation, the CI reported constant pain in his knee.  Pain was approximately 4 out of 10 with walking and jumped up to 6-8/10 with running.  Pain was 3-4/10 with sitting.  He stated he could walk approximately 1/2 mile before the pain stopped.  Going up or down stairs increased the amount of pain from 4 out of 10 to 6 to 7 out of 10.  He stated he also heard constant clicking and popping but there had not been a mechanical block in his knee.  The physical examination noted a mildly antalgic (assuming a gait or posture to lessen pain) gait.  There was right knee joint line tenderness (medial > lateral).  Right knee ROM was flexion of 79 (140) and extension of 3 (0) degrees.  “At 79 degrees, he refused to flex any more.  Passive, he refused to go past that point secondary to pain; however, there did not appear to be a mechanical block.” The Lachman (assesses anterior cruciate ligament [ACL]) test was Grade 1/A (< 5mm translation/firm endpoint).  The posterior drawer (assesses posterior cruciate ligament [PCL]) test was negative.  The valgus/varus stress (assesses medial collateral ligament [MCL]/lateral collateral ligament [LCL]) test revealed no laxity.  Strength, sensation, pulses, and deep tendon reflexes (DTRs) were normal.  

The Board directed attention to its rating recommendation based on the above evidence.  The PEB rated the right knee condition 0%, coded 5099-5003 (degenerative arthritis), citing AR 635-40, paragraph B-15 (zero percent ratings).  The VA rated the right knee condition 0%, coded 5099-5257 (other impairment of knee), citing the service treatment records and noting the CI failed to report for the scheduled VA C&P examination.  There was no limitation of flexion or extension that supported a rating under the VASRD diagnostic codes for limitation of motion (5260 or 5261).  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.  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).  However, there was evidence of painful motion with functional loss supporting a 10% rating (based on §4.59, §4.40 and §4.45).  The 5259 code (cartilage, semilunar, removal of, symptomatic) was also applicable in this case, and provided an alternate route to a 10% rating.  After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the Board recommends a disability rating of 10% for the right knee pain condition, coded 5259.  

BOARD FINDINGS:  In the matter of the right knee condition, the Board unanimously recommends a disability rating of 10%, coded 5259 IAW VASRD §4.71a.  There were no other conditions within the Board’s scope of review for consideration.  

The Board recommends that the CI’s prior determination be modified as follows, effective as of the date of the prior medical separation:  

CONDITION	VASRD CODE	PERMANENT RATING	
Right Knee Chondromalacia	5259	10%	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20150602, 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

SUBJECT:  Department of Defense Physical Disability Board of Review Recommendation for 
XXXXXXXXXXXXXXXXXX, AR20170000737  (PD201500662)

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