RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2015-02165
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20090418

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E2, Multichannel Transmission Systems Operator/Maintainer, medically separated for “right knee chondromalacia patella [CMP],” with a disability rating of 10%.

CI CONTENTION:  The CI’s conditions continue to worsen and negatively impacts daily activities.  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 - 20090313	No VA Claim	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Right Knee CMP	5099-5003	10%	No VA Claim	--	--	--	
Chronic Right Hip Pain	Not Unfitting					
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  --	

ANALYSIS SUMMARY:  

Right Knee Chondromalacia Patella.  According to service treatment records (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI was initially evaluated for left knee pain on 6 June 2008, near the completion of basic training.  The examination of the right knee was normal and she was treated with medications and duty restrictions.  On 11 July 2008, she was seen in the emergency room for the sudden onset of right knee pain which began during a 7 mile march.  Her examination was essentially unremarkable and the gait was normal.  An X-ray was normal other than a probable artifact.  She was seen in primary care 3 days later and reported a 1 month history of pain.  Motion was painful past flexion of 75 degrees, but the remainder of the examination including gait was normal.  A bone scan on 7 August 2008 was normal.  She was referred for physical therapy (PT).  An MRI on 30 January 2009 showed mild irregularity of the kneecap (patella) cartilage which were likely secondary to mild chondromalacia patella (CMP); it was otherwise unremarkable.  In PT on 2 February 2009, she had continued pain and to had partially met treatment goals.  On examination, the range of motion (ROM) of the knees was full.  Diffuse tenderness was present.  Pain was present behind the kneecaps, but there were no signs of meniscal irritation or instability.  The gait was normal and the CI was able to squat albeit with pain.  The CI was entered into the MEB process the next day for CMP of the right knee.  The MEB NARSUM was dated 19 February 2009, 2 months prior to separation.  The gait and strength were normal without instability, effusion, or laxity.  There was mild joint line tenderness.  The ROM showed flexion of 138 degrees (normal 140) and normal extension of 0 degrees (normal 0) with painful motion present.  There was not a VA Compensation and Pension (C&P) examination in evidence.  The MEB forwarded uncomplicated right knee pain consistent with chondromalacia patella for PEB adjudication.  

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 limitation of motion of 1 major joint.  There was evidence of painful motion with functional loss supporting a 10% rating (based on §4.59, §4.40 and §4.45) as adjudicated by the PEB.  There was no limitation of motion, ligamentous instability or laxity, or meniscal disease to support a higher rating.  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.  

Contended PEB Conditions:  Chronic Right Hip Pain.  The Board’s main charge is to assess the fairness of the PEB’s determination that the contended condition was not unfitting.  The contended condition was profiled, but was not specifically implicated in the commander’s statement.  It was judged to meet retention standards.  The final clinical note addressing the right hip was 6 months prior to separation.  The NARSUM did not address right hip pain as a current problem.  There was no performance-based evidence from the record that the condition significantly interfered with satisfactory duty performance at separation.  After due deliberation, the Board concluded that there was insufficient cause to recommend a change in the PEB fitness determination for the contended condition and so no additional disability rating is recommended.  

BOARD FINDINGS:  In the matter of the right knee chondromalacia patella condition and IAW VASRD §4.71a, the Board unanimously recommends no change in the PEB adjudication.  In the matter of the contended chronic right hip pain condition, the Board unanimously recommends no change from the PEB determination as not unfitting.  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 20150801, w/atchs
Exhibit B.  Service Treatment Record

AR20170004212, 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,