RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2015-01634
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20081125

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E5, Human Resources Specialist, medically separated for “bilateral chondromalacia patella,” rated 10% for each knee, with a combined disability rating of 20%.  

CI CONTENTION:  The CI contended bilateral knees, PTSD, adjustment disorder/depression and migraines.  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 - 20080811	VARD – 20090110/20090225	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Bilateral Chondromalacia Patella	5099-5003	20%	Bilateral Chondromalacia of the Knees	5099-5014	10%	20081030	
Adjustment D/O with Anxiety and Depressed Mood	Not Unfitting 	PTSD 	9411	50%	20081024	
Chronic Tension, Migraine Headaches		Migraines	8100	30%	20081030	
COMBINED RATING:  20%	COMBINED RATING OF ALL VA CONDITIONS:  80%	

ANALYSIS SUMMARY:  

Bilateral Chondromalacia Patella.  According to service treatment records (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s bilateral knee condition began in June 2005 when the CI was running and felt her left knee pop.  She continued to run for 1 mile when she reported her left knee “locked-up.”  The CI sought medical care and reported she was told her kneecap was sitting too high.  Diagnostic imaging showed a right knee displaced patella with a normal left knee.  In August 2005, the CI complained of bilateral knee pain with indications of retropatellar pain syndrome.  In October 2005, the CI was diagnosed with iliotibial band syndrome.  On January 28, 2006, Magnetic Resonance Imaging studies of the right and left knee were normal.  The CI then deployed to Afghanistan where she was diagnosed with bilateral patellofemoral syndrome.  On 26 November 2007, the orthopedic examination showed gross patellofemoral crepitus with the patellae being hypermobile.  The examiner was able to fully dislocate the patella medially and laterally.  In January 2008, the CI was given a permanent profile.  Despite treatment, the bilateral condition could not be adequately rehabilitated to meet the physical requirements of the CI’s military specialty and the CI was referred for MEB.  The MEB forwarded “chondromalacia patellae bilateral, severe” for PEB adjudication.  

The 28 May 2008 MEB NARSUM examination, 6 months prior to separation, noted complaints of discomfort, tightness, and a sense of stiffness to both knees.  Each knee was separately examined and documented with similar findings.  Each knee had tenderness and a hypermobile patella.  There was retropatellar crepitus with a “crunching-type sound” which caused pain.  There was no laxity or instability.  McMurray test (test for meniscus symptoms) caused pain.  The range of motion (ROM) was painful with flexion of 145 degrees (normal 140), and hyperextension of -10 degrees (normal 0).  

At the 20 October 2008 VA Compensation and Pension (C&P) evaluation, performed 1 month before separation, the CI reported pain and swelling of both knees, the right worse than the left.  Pain and grinding was reported when going up and down stairs.  X-rays of the knees showed no evidence of arthritic disease or other significant abnormality.  Physical examination showed a normal posture and gait.  There was bilateral retropatellar crepitus with positive apprehension tests, and pain on ROM.  There was no laxity or instability and the McMurray test was negative.  ROM was painful with flexion of 130 degrees extension to 0 degrees, with additional pain and 5 degrees loss on repetitive motion.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the right and left knee condition 10% each, for a combined 20% rating, coded 5099-5003 (arthritis, degenerative) citing painful motion.  The VA rated the bilateral knee condition 10% coded 5099-5014 (osteomalacia), based on the C&P examination 1 months before separation, citing painful motion or limited motion.  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 painful motion with functional loss supporting a 10% rating (based on §4.59, §4.40 and §4.45) for each knee as adjudicated by the PEB.  There was no history of dislocated meniscus or loose body causing frequent locking with recurrent effusions (5258).  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 combined 20% adjudicated by the PEB under any applicable code.  After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the panel concluded that there was insufficient cause to recommend a change in the PEB adjudication for the bilateral knee condition.  

Contended PEB Conditions:  Adjustment D/O (Disorder) with Anxiety and Depressed Mood and Chronic Tension, Migraine Headaches.  The panel’s main charge is to assess the fairness of the PEB’s determination that the contended conditions were not unfitting.  The adjustment disorder is a condition not constituting a physical disability, IAW DoDI 1332.38.  Therefore, the panel has no basis for recommending it as unfitting.  The headache condition was not profiled, implicated in the commander’s statement, or judged to fail retention standards.  There was no performance-based evidence from the record that headaches significantly interfered with satisfactory duty performance at separation.  After due deliberation, the panel concluded that there was insufficient cause to recommend a change in the PEB fitness determination for any of the contended conditions and so no additional disability ratings are recommended.  After due deliberation, the panel concluded that there was insufficient cause to recommend a change in the PEB fitness determination for contended conditions and so no additional disability ratings are recommended.  

BOARD FINDINGS:  In the matter of the bilateral knee condition and IAW VASRD §4.71a, the panel unanimously recommends no change in the PEB adjudication.  In the matter of the contended adjustment disorder and migraine headache conditions, the panel unanimously recommends no change from the PEB determinations as not unfitting.  There are no other conditions within the panel’s scope of review for consideration.  The panel, therefore, recommends that 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 20150622, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

	

AR20170009561, XXXXXXXXXXXXXXXXXX

XXXXXXXXXXXXXXXXXX

Dear XXXXXXXXXXXXXXXXXX

	The Department of Defense Physical Disability Board of Review (DoD PDBR) reviewed your application and found your separation disability rating and your separation from the Army for disability with severance pay to be accurate.  I have reviewed the Board’s recommendation and record of proceedings (copy enclosed), and I accept its recommendation.  I regret to inform you that your application to the DoD PDBR is denied.  

	This decision is final.  Recourse within the Department of Defense or the Department of the Army is exhausted; however, you have the option to seek relief by filing suit in a court of appropriate jurisdiction.

Sincerely,					      
						      					
Enclosure