RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2015-01850
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20020304

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E1, Infantryman, medically separated for right knee pain, with a disability rating of 0%.  

CI CONTENTION:  “Review all conditions.” The CI’s 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 panel 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 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 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 - 20020131	VARD	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Pain, Right Knee, due to Chondromalacia	5299-5003	0%	No VA examination in evidence	
COMBINED RATING:  0%	COMBINED RATING ALL VA CONDITIONS:  	

ANALYSIS SUMMARY:  

Chronic Pain, Right Knee.  There was a paucity of source clinical notes in the available service treatment record (STR) for this case, and the Board’s recommendation was derived primarily from the Medical Evaluation Board (MEB) narrative summary (NARSUM) and core military Disability Evaluation System documents.  The CI suffered right knee pain at service entry (football injury) and re-injured after a parachute jump in Airborne School.  A magnetic resonance imaging showed an osteochondral defect.  Orthopedics diagnosed a right patellar grade IV chondromalacia patella and recommended a diagnostic arthroscopy, however, the CI declined surgical intervention.  A trial of conservative treatment did not result in sufficient improvement to allow unrestricted duty; and, the CI was referred for an MEB which in turn forwarded “chronic right knee pain due to [Grade] IV chondromalacia” to the PEB.
The NARSUM examination on 15 October 2001, 5 months before separation, documented worsening knee pain rated minimal and constant, exacerbated by “going up and down stairs, squatting and prolonged periods of knee bending.”  The physical examination recorded patellar tenderness with crepitus, no effusion, stability to stress testing in all planes, and no signs of meniscal impingement (locking).  The recorded range of motion (ROM) was flexion of 140 degrees (normal) and extension of minus 5 degrees (normal 0, minus 10 degrees for minimum 10%), without comment regarding painful motion.  

There was no VA claim, evaluation, or treatment; and, there was no other post-separation evidence in this case.

The Board directed attention to its rating recommendation based on the above evidence.  The PEB rated the right knee condition 0%, analogously coded 5003 (arthritis, degenerative), citing the US Army Physical Disability Agency (USAPDA) pain policy.  Members agreed, however, that VASRD §4.59 (painful motion) and §4.40 (functional loss) was reasonably supported by the evidence and fairly conceded in support of the minimum compensable 10% rating.  Although painful motion was not specified in the single ROM examination in evidence, the presence of crepitus is a §4.59 indicator; and, the “painful on use” criterion of §4.40 was easily inferred from the history.  There was no ROM limitation, persistent effusion and locking, or fracture with non-union or malunion to achieve a rating higher than 10% under any applicable code; and, there was no evidence of joint instability for separate rating.  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 right knee condition; analogously coded 5014 (osteomalacia) for its clinical compatibility.  

BOARD FINDINGS:  In the matter of the chronic pain, right knee condition, the Board unanimously recommends a disability rating of 10%, coded 5099-5014 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, Right Knee	5099-5014	10%	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20150705, w/attachments
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Recor

AR20170003953, XXXXXXXXXXXXXXXXXX

Dear XXXXXXXXXXXXXXXXXX:

	The Department of Defense Physical Disability Board of Review (DoD PDBR) reviewed your application and found that your disability rating should be modified but not to the degree that would justify changing your separation for disability with severance pay to a permanent retirement with disability.  I have reviewed the Board’s recommendation and record of proceedings (copy enclosed) and I accept its recommendation.  This will not result in any change to your separation document or the amount of severance pay.  A copy of this decision will be filed with your Physical Evaluation Board records.  I regret that the facts of the case did not provide you with the outcome you may have desired.
  
	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. 

	A copy of this decision has also been provided to the Department of Veterans Affairs.

Sincerely,