RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2015-00916
BRANCH OF SERVICE:  Army	SEPARATION DATE:  20031217

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E2, Basic Trainee, medically separated for “chondromalacia right knee,” with a disability rating of 0%.

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 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 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 - 20031203	VARD – 20050302	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chondromalacia Right Knee	5099-5003 	0%	Right Knee Status Post Medial Patellofemoral Ligament Repair	5257	20%	20041208	
COMBINED RATING:  0%	COMBINED RATING OF ALL VA CONDITIONS:  20%	

ANALYSIS SUMMARY:  

Chondromalacia Right Knee.  According to service treatment record (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI underwent right knee arthroscopy on 25 July 2003 which showed some medial patellar facet chondromalacia (inflammation under the patellar) and lateral patellar laxity.  The CI medial patellofemoral ligament was repaired but further treatment did not result in improvement sufficient to allow unrestricted duty.  The MEB forwarded “status post right patellar dislocation with medial patellofemoral ligament repair and subsequent posttraumatic chondromalacia patella” for PEB adjudication.

The MEB NARSUM examination on 23 October 2003, 2 months prior to separation, noted complaints of pain with walking greater than three quarters of a mile, inability to run without significant discomfort, and inability to squat.  Physical examination showed range of motion (ROM) of extension 0 degrees and flexion 140 (normal 0 to 140).  There was no instability to the knee or significant tenderness to palpation.

The 8 December 2004 VA Compensation and Pension (C&P) General evaluation, performed 12 months after separation, noted complaints of continued pain without swelling or decrease in knee movement.  Physical examination showed a well healed right medial portion of the knee scar.  There was no swelling or tenderness, and sensation and motor function were intact.  At the 14 December 2004 VA C&P Joints evaluation, performed 12 months after separation, the CI reported continued right kneecap pain with popping and grinding.  The CI reported his knee cap felt unstable and was unable to play basketball or other sports.  He experienced occasional swelling with a lot of walking and/or running.  He was working a desk job without much functional problems.  Physical examination demonstrated medial patella tenderness and a well-healed surgical scar.  There was no swelling and ROM was flexion 135 degrees and extension 0 degrees.  There was significant laxity with lateral stress testing and a positive patellar grind test.  The knee was otherwise stable.

The Board directed attention to its rating recommendation based on the above evidence.  The PEB rated the right knee condition 0%, analogously coded 5099-5003 (degenerative arthritis), citing pain recurrent with vigorous knee use.  The VA rated the right knee condition 20%, coded 5257 (knee, other impairment of: recurrent subluxation or lateral instability), based on the VA C&P examination 12 months after separation, citing moderate recurrent subluxation or lateral instability of the knee.  The Board agreed there was no limitation of flexion or extension that supported a rating under the VASRD diagnostic codes for limitation of motion (5260 or 5261).  While the STR evidence did show the CI experienced patella instability, the MEB NARSUM examination most proximate to separation did not demonstrate ligamentous instability or laxity (5257) which imposed a functional limitation.  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).  However, there was evidence of painful motion with functional loss supporting a 10% rating (based on §4.59, §4.40 and §4.45).  The Board does not recommend a disability rating for scars unless their presence imposes a direct functional limitation that renders the CI unfit.  The knee scars did not interfere with wear of military gear and were not painful at the MEB examination.  There was insufficient evidence of duty-limiting impairment from the knee scars, thus the Board concluded that the scars condition could not be recommended for additional disability rating.  After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the Board recommended a disability rating of 10% for the right knee condition, coded 5099-5003.

BOARD FINDINGS:  In the matter of the right knee condition, the Board unanimously 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	
Right Knee Chondromalacia	5099-5003	10%	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20150608, 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, AR20170000753 (PD201500916)

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