RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2016-00323
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20090707

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

CI CONTENTION:  “Review all conditions.”  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 - 20090330	VARD – 20160913	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Left Knee Patellar Chondromalacia with Chronic Pain	5099-5003	10%	Left Knee Meniscal Tear with Degenerative Arthritis	5257	Deferred	20160714	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  30%	

ANALYSIS SUMMARY:  

Left Knee Patellar Chondromalacia with Chronic Pain.  According to the service treatment record (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI underwent left knee surgery in May 2008 (12 months prior to separation) for a torn medial meniscus.  

The 24 January 2009 MEB NARSUM examination, 6 months after surgery and 6 months prior to separation, noted complaints of daily aching left knee pain, with complaints of his “knee popping all the time and that sometimes it locks up.”  The CI indicated that if he was on his feet for long periods of time or did any running at all, it caused constant soreness and swelling.  He also experienced extreme pain and swelling when climbing up and down on aircraft and walking around the hanger.  Physical examination (referred to the MEB examination performed by the NARSUM physician) showed a normal knee.  The 27 January physical therapy formal ROM evaluation showed flexion of 140 degrees (normal 140) and extension of 1 degree hyper-extension (normal 0 degrees).  

There was no VA examination in evidence proximate to separation.  The panel noted remote VA evidence of worsened left lower extremity symptoms and findings in 2016, over 6 years after separation.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the “left knee patellar chondromalacia with chronic pain” condition 10%, coded 5099-5003 (analogous to arthritis, degenerative), citing painful motion.  Remote evidence was adjudged as post-separation worsening and not descriptive of the CI’s disability picture at separation.  

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) as adjudicated by the PEB.  The CI did have a history of meniscal surgery, however there was insufficient evidence of dislocated meniscus or loose body causing frequent locking with recurrent effusions to support rating under 5258 (cartilage, semilunar, dislocated).  Alternative rating analogous to code 5259 (cartilage, semilunar, removal of, symptomatic) was applicable in this case, but the maximum 10% rating under that code (which includes painful motion) provided no benefit to the CI.  There was therefore no VASRD §4.71a 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 panel concluded that there was insufficient cause to recommend a change in the PEB adjudication for the “left knee patellar chondromalacia with chronic pain” condition.  

BOARD FINDINGS:  In the matter of the “left knee patellar chondromalacia with chronic pain” 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 20160515, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

	

AR20170015278, 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