anRECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXX	CASE:  PD-2015-01411
BRANCH OF SERVICE:  Air Force 	SEPARATION DATE:  20041108

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty, E6, Instructor Electronic Signal Intelligence Exploitation Craftsman, medically separated for “right knee pain secondary to chondromalacia patellae” with a disability rating of 20%.  

CI CONTENTION:  “Review all conditions.”  The complete submission is at Exhibit A.  

SCOPE OF REVIEW:  The panel’s scope of review is defined in DoDI 6040.44.  It is limited to review of disability ratings assigned 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 or non-compensable.  Any conditions outside the panel’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 panel’s authority is limited to assessing the fairness and accuracy of PEB rating determinations and recommending corrections, where appropriate.  The panel’s assessment of the PEB rating determination 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(s) at the time of separation.  The panel 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 panel 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 - 20040915	VARD - 20050902	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Right Knee Pain Secondary to Chondromalacia Patellae	5257	20%	Chondromalacia and Arthroplasty Residuals, Right Knee	5299-5260	0%	STR	
COMBINED RATING:  20%	COMBINED RATING OF ALL VA CONDITIONS:  0%	

ANALYSIS SUMMARY:  

Right Knee Pain Secondary to Chondromalacia Patellae.  According to the service treatment record (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s right knee condition gradually developed worsening anterior knee pain which began in February 2002.  The CI underwent an arthroscopic surgery (excision of plica, chondroplasty of the trochlear, lateral release, and debridement) on 6 August 2003.  

The 11 August 2004 MEB NARSUM orthopedic examination, 3 months prior to separation, noted complaints of frequent anterior right knee pain with ambulation and any sort of physical activity including running and bicycling.  Physical examination showed range of motion (ROM) of 0-130 degrees (0-140 degrees normal), mild tenderness in the medial and lateral joint lines, and “marked pain that reproduces (the CI’s) symptoms of patellofemoral grind.”  There was no laxity or instability, and no pain with McMurray testing (for meniscal pathology).  The examiner noted that an arthrogram revealed post-surgical and cartilage changes in the undersurface of the patella and trochlea.  The CI reasonably declined additional surgery.  

The CI did not appear for a VA Compensation and Pension evaluation proximate to separation.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the right knee condition 20%, coded 5257 (knee, other impairment of:  Recurrent subluxation or lateral instability).  The VA rated the chondromalacia and arthroplasty residuals, right knee condition 0%, coded analogous to 5260 (leg, limitation of flexion of), based on the STR, citing a lack of evidence showing recurrent slight subluxation or instability.  

There was no evidence of severe subluxation or lateral instability to support a 30% rating under the 5257 code (knee, other impairment of).  There was no limitation of flexion or extension that supported a rating under the VASRD diagnostic codes for limitation of motion (5260 or 5261).  There was no history of surgery to remove a meniscus (5259), and no history of dislocated meniscus or loose body causing frequent locking with recurrent effusions (5258) to support a rating under those respective codes.  Finally, there was no fracture, nonunion, or malunion of the femur or tibia to support consideration under the respective codes for knee impairment related to long bone conditions (5255, 5262).  No additional functional limitation was evidenced by the examinations.  After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the panel concluded 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 pain secondary to chondromalacia patellae condition and IAW VASRD §4.71a, the panel unanimously recommends no change in the PEB adjudication.  There are no other conditions within the panel’s scope of review for consideration.  The panel, therefore, recommends there be no modification or re-characterization of the CI’s disability and separation determination.  

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20150617, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

SAF/MRB
1500 West Perimeter Road, Suite 3700
Joint Base Andrews, MD  20762

XXXXXXXXXXXXXXXXXXX

Dear XXXXXXXXXXXXXXXXXXX:

Reference your application submitted under the provisions of DoDI 6040.44 (Section 1554, 10 USC), PDBR Case Number PD-2015-01411.

After careful consideration of your application and treatment records, the Physical Disability Board of Review determined that the rating assigned at the time of final disposition of your disability evaluation system processing was appropriate.  Accordingly, the Board recommended no re-characterization or modification of your separation.

I have carefully reviewed the evidence of record and the recommendation of the Board.  I concur with that finding and their conclusion that re-characterization of your separation is not warranted.  Accordingly, I accept their recommendation that your application be denied.

Sincerely,

XXXXXXXXXXXXXXXXXXX
Director
Air Force Review Boards Agency

Attachment:
Record of Proceedings