RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXX	CASE:  PD-2015-02323
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20040506

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

CI CONTENTION:  “Condition is steadily getting worse and starting to interfere with current civilian employment.”  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 - 20040408	VARD – NA 	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chondromalacia Patellar Right Knee with Osteochondral Lesions	5099-5003	10%	No VA Exam in Evidence	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  NA 	

ANALYSIS SUMMARY:  

Chondromalacia Patellar Right Knee with Osteochondral Lesions.  According to the service treatment record (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s chondromalacia patellar right knee with osteochondral lesions condition began in February 2001 after experiencing a hyperextension injury.  The CI re-injured his right knee with another hyperextension injury in May 2003.  There was no surgical indication.  

At the 21 November 2003 orthopedic clinic appointment, the examiner recorded an antalgic gait, positive medial joint line tenderness, positive McMurray’s and limited range of motion (ROM).  ROM was recorded as -10 degrees extension (normal 0) stating “unable to fully extend.”  Flexion was 100 degrees (normal 140).  Three days later, at another orthopedics clinic follow-up, extension was listed as 0 degrees (normal) and flexion to 135 degrees (normal 140).  In December 2003, the orthopedic surgeon noted extension of 0 degrees and flexion of 110 degrees.  An MRI was ordered to rule out a medial meniscus tear or a bucket handle tear.  The 7 December 2003 MRI showed patellar cartilage loss and subchondral edema with no meniscal tear.  

The 20 February 2004 MEB NARSUM examination, 3 months prior to separation, noted complaints of right knee pain and grinding.  Physical examination showed no edema, ecchymosis or obvious deformity.  There was a palpable grind with extension.  ROM was recorded as full extension being 180 degrees instead of the standard 0 degrees.  Extension to 180 degrees (presumed to be 0 degrees (normal)) and flexion was described as to 45 degrees (135 degrees in the standard annotation (140 normal)).  Guarding was noted which suggests painful motion.  

There was no VA examination in evidence proximate to separation.

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the right knee condition 10%, coded 5099-5003 (analogous to arthritis, degenerative), citing reduced flexion.  There was no limitation of motion which supported a rating under the diagnostic codes for limitation of motion (5260 or 5261).  However, there was evidence of painful motion with functional loss supporting a minimum, 10% rating (based on §4.59, §4.40 and §4.45).  
There was no history of dislocated meniscus or loose body causing frequent locking with recurrent effusions (5258) or history of surgery to remove a meniscus (5259) to support a rating under those 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. 

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 chondromalacia patellar right knee with osteochondral lesions condition.  

BOARD FINDINGS:  In the matter of the “chondromalacia patellar right knee with osteochondral lesions” 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 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 20150830, w/atchs
Exhibit B.  Service Treatment Record

AR20170012485, XXXXXXXXXXXXXXXXXXX 

XXXXXXXXXXXXXXXXXXX

Dear XXXXXXXXXXXXXXXXXXX:

	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