RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2015-00691
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20080420

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

CI CONTENTION:  The CI makes no contentions.  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 - 20080212	VARD - 20080422	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chondromalacia Patella, Left Knee…	5099-5003	0%	Chondromalacia Left Knee	5262-5024	0%	20071031	
COMBINED RATING:  0%	COMBINED RATING OF ALL VA CONDITIONS:  0%	

ANALYSIS SUMMARY:  

Chondromalacia Patella, Left Knee.  According to service treatment records and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s left knee condition began in November 2006 after a twisting injury.  Radiographic studies showed no evidence of a fracture, dislocation or other abnormalities.  Magnetic resonance imaging in January 2007 showed mild chondromalacia of the patella with minimal joint effusion seen in the left knee joint space.  At the time of the Orthopedics clinic appointment on 19 July 2007, the CI reported an injury to his left knee when he twisted it, stepping in a hole on a ruck march in April 2006.  On examination there was genu valgum of both knees (“knock-knee.”)  There was tenderness to palpation (TTP) of the left knee with normal motion and patellofemoral crepitus.  There was no effusion or evidence of instability or meniscal injury.  The orthopedic specialist noted that imaging showed a lateral patella with chondromalacia and the CI was diagnosed with patellofemoral syndrome.  There was no surgical indication.  Despite treatment, the left knee condition could not be adequately rehabilitated to meet the physical requirements of the CI’s military specialty and the CI was referred for an MEB.  The MEB forwarded “mild chondromalacia of the patella, left knee” for PEB adjudication.

The MEB DD examination and VA C&P examinations were done in conjunction, dated 31 October 2007, 6 months prior to separation.  The CI reported symptoms of pain and swelling, aggravated by prolonged standing, running and climbing, with flare-ups four times per week that lasted for hours.  Physical examination showed a normal gait and the CI was not using a cane or a crutch.  There was no TTP of the knee.  There was no evidence of instability or meniscal damage.  Left knee range of motion (ROM) was extension 0 degrees (normal 0) and flexion 140 degrees (normal 140) and there was no limitation in ROM from pain, fatigue, weakness, or lack of endurance with repetitive use.  Lower extremity strength, sensation, and reflexes were normal.  The examiner diagnosed left knee, mild chondromalacia of the patella with minimal joint effusion.  

At the MEB NARSUM on 16 January 2008 the CI reported chronic bilateral knee pain.  Physical examination of the left knee showed TTP of the patellofemoral region with crepitus.  There was no effusion or evidence of instability or meniscal pathology.  Patellar apprehension test was negative.  Physical therapy measured ROM for the MEB on 2 November 2007.  Left knee extension was 0 degrees and flexion was 130 degrees after 3 repetitions.  The MEB NARSUM examiner noted that during ROM the CI did not indicate any pain.  

The Board directed attention to its rating recommendation based on the above evidence.  The PEB rated the left knee condition 0%, coded 5099-5003 (analogous to degenerative arthritis), in accordance with US Army Physical Disability Agency’s Policy/Guidance Memorandum #12 (Table of Analogous Codes), citing inability to squat and climb, both necessary tasks for working on aircrafts.  The VA rated the left knee condition 0%, dual coded 5262-5024 (impairment of tibia and fibula; and tenosynovitis) citing absence of painful or limited motion.  

A 10% rating was supported for limited ROM of a major joint with imaging evidence of degenerative arthritis for patellar chondromalacia coded analogous to 5003 or a code rated according to 5003 criteria.  There was no limitation of flexion or extension that supported a higher 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) or history of surgery to remove a meniscus (5259) 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).  There was therefore 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 recommends a disability rating of 10% for the chondromalacia patella, left knee condition, coded 5009-5003.  

BOARD FINDINGS:  In the matter of the chondromalacia patella, left knee condition, the Board unanimously or majority recommends a disability rating of 10%, coded 5099-5003 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	
Chondromalacia Patella, Left Knee	5099-5003	10%	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20150603, 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, AR20170000052 (PD201500691)

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