RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXXXX	CASE:  PD-2015-02527
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20031126

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E3, Medical Specialist Trainee, medically separated for “chronic pain, right knee due to chondromalacia,” with a disability rating of 10%.  

CI CONTENTION:  “Review all conditions.”  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 - 20031022	VARD - 20040913	
Condition	Code	Rating	Condition	Code	Rating	Exam	
R Knee Pain due to Chondromalacia	5099-5003	10%	Chondromalacia R Knee	5299-5257	10%	20040806	
Cyclic Mood Disorder	Not Unfitting 	Depressive Disorder	9434	10%	20040723	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  30%	

ANALYSIS SUMMARY:  

Right Knee Pain due to Chondromalacia.  According to service treatment records (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI first had problems with her right knee condition in 1997.  She was thought to have patellar (kneecap) tendonitis which resolved without apparent sequelae.  This was disclosed on an initial accession examination in December 1997 (accession was denied for an unrelated problem), but not noted on the 19 December 2002 accession evaluation.  She entered active duty on 12 February 2003 and presented on 19 March 2003 with a history of right knee pain for the past several weeks.  No specific trauma was reported.  The examination was unremarkable other than painful motion and tenderness with patellar compression.  She was treated conservatively with non-steroidal anti-inflammatory medications, physical therapy (PT), and activity modification without resolution of her symptoms.  On 13 June 2003, X-rays of the right knee were remarkable for a collection of fluid (effusion) above the kneecap (suprapatellar), but otherwise without abnormalities.  An MRI on 19 August 2003 was significant for degeneration of the cartilage beneath the kneecap (chondromalacia patella), but otherwise normal.  The previously noted effusion was resolved.  Despite treatment, the right knee condition could not be adequately rehabilitated to meet the physical requirements and allow completion of the CI’s military specialty.   

At the MEB examination (recorded on DD Forms 2807 and 2808) dated August 2003, 3 months prior to separation, the CI reported right knee pain.  The physical examination noted pain with a patellar grind.  The MEB NARSUM examination on 15 September 2003, 2 months prior to separation, noted complaints of pain with prolonged standing or walking and with any running.  The physical examination showed tenderness to palpation along the medial and lateral side of the undersurface of the patella, crepitus, tenderness to palpation along the anterior joint line (between the shin bone and femur).  There was no effusion and muscle strength was normal.  The knee was stable and signs of meniscal irritation were absent.  The range of motion (ROM) was reduced with flexion limited to 110 degrees (normal 140), but painful motion was not recorded.  The MEB forwarded “right knee chondromalacia” for PEB adjudication.  

At the VA Compensation and Pension (C&P) evaluation performed on 6 August 2004, 8 months after separation, the CI reported she avoided kneeling, squatting and stooping.  The physical examination showed tenderness on palpation of the right patellar tendon and the medial aspect of the knee at the joint line.  There was no crepitus on active motion.  McMurray’s testing was negative.  There was slight bilateral instability in the anterior/posterior and the medial/lateral planes (the Board noted that this was not recorded on multiple prior examinations).  The ROM was normal and pain free.  Strength was normal.  After repetitive activity there was no change in motion or pain pattern.  The gait was normal and the CI got on and off the examination table without difficulty.  Bilateral joint space narrowing was present on X-rays.  

The Board directed attention to its rating recommendation based on the above evidence.  The PEB rated the right knee condition 10%, coded 5099-5003 (degenerative arthritis), citing the US Army Physical Disability Agency pain policy. The VA also rated the right knee condition 10% coded 5299-5257 (knee, other impairment of, recurrent subluxation or lateral instability) based on the C&P examination 8 months after separation, citing slight recurrent subluxation or lateral instability.  There was evidence of painful motion with functional loss supporting a 10% rating (based on §4.59, §4.40 and §4.45).  The examinations proximate to separation did not demonstrate compensable limitation of motion, the presence of ligamentous instability or laxity, or meniscal pathology to support a higher rating.  There was no route to a rating higher than the 10% adjudicated by the PEB under any applicable code, and no grounds for additional rating based on the presence of instability.  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:  Cyclic Mood Disorder.  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 not profiled or implicated in the commander’s statement.  It was judged to meet retention standards.  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 condition and IAW VASRD §4.71a, the Board unanimously recommends no change in the PEB adjudication.  In the matter of the contended cyclic mood disorder 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, 20151104, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

AR20170004631, XXXXXXXXXXXXXXXXXXXXX

XXXXXXXXXXXXXXXXXXXXX

Dear XXXXXXXXXXXXXXXXXXXXX:

	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