RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2015-01086
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20091118

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E4, Parachute Rigger, medically separated for “right knee chondromalacia patella,” with a disability rating of 10%.

CI CONTENTION:  The CI requests 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 - 20090813	VARD - 20101203	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Right Knee Chondromalacia Patella	5099-5003	10%	Chondromalacia, Right Knee	5260	0%	20100203	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  0%	

ANALYSIS SUMMARY:  

Right Knee Chondromalacia Patella.  According to service treatment records and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s right knee condition began in 2007 after hyperextending the knee during martial arts training.  In March 2008, the CI experienced increased pain with physical activity.  Radiographic studies in May 2008 showed Grade II chondromalacia of the patella and follow- up studies in May 2009 showed irregularities of the femoral condyles.  There was no surgical indication.  Despite treatment, the right 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 “right knee chondromalacia patella” for PEB adjudication.  

At the time of orthopedic clinic appointment on 13 March 2009, the CI experienced pain and some grinding in the patella.  On examination the CI flexed the knee to 125 degrees (normal 140) and extended it to 0 degrees (normal 0).  At a 19 May 2009 physical therapy examination, the examiner noted a flexion on average of 130 degrees and extension of 0, with a normal gait and pain did not limit the CI’s range of motion (ROM).  Additionally, the knee appearance was normal and showed no instability.  During the MEB examination (recorded on DD Forms 2807 and 2808) dated 30 June 2009, 5 months prior to separation, the CI reported experiencing ongoing knee pain.  Physical examination showed mild tenderness to palpation, some grinding, no instability and full ROM.  The MEB NARSUM, dated 30 June 2009, indicated the same physical findings from the DD Form 2807 and 2808.   

At the 3 February 2010 Compensation and Pension (C&P) evaluation, performed 3 months after separation, physical examination showed a normal gait, no patellar grinding, instability or other knee abnormalities.  The CI demonstrated a flexion to 140 degrees and extension to 0 degrees, without pain.  Additional limitation of motion after repetition was absent.  

The Board directed attention to its rating recommendation based on the above evidence.  The PEB rated the right knee condition 10%, coded 5099-5003 (analogous to degenerative arthritis), citing near normal ROM, and mild patellar tenderness to palpation, patellar grind, no instability and a normal gait.  The VA rated the right knee condition 0%, coded 5260 (leg, limitation of flexion), citing normal ROM, no painful motion or additional limitation of motion after repetition and no instability.  There was no limitation of motion which supported a rating under the diagnostic codes for limitation of flexion or extension (5260, 5261).  However, there was evidence of functional loss supporting a 10% rating (based on §4.40 and §4.45) as adjudicated by the PEB. 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).  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 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 right knee chondromalacia patella condition and IAW VASRD §4.71a, the Board 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 20150611, 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, AR20170002603 (PD201501086)

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