RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXX	CASE:  PD-2016-00387
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20071118

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E5, Infantryman, medically separated for “chronic left knee pain” rated 0%.

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 - 20070809	VARD - 20080404	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Left Knee Pain, Chondromalacia	5099-5003	0%	Left Knee Chondromalacia	5260	10%	20070702	
RATING:  0%	COMBINED RATING OF ALL VA CONDITIONS:  10%	

ANALYSIS SUMMARY:  

Chronic Left Knee Pain.  According to the service treatment record (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI injured his left knee (mechanism unknown) in November 2004.  In December 2005 (2 years before separation) he underwent diagnostic arthroscopy which identified chondromalacia (damaged joint cartilage) that was debrided (no mention of meniscal or ligament pathology or intervention).  There was no evidence from STR clinical entries that was probative to range of motion (ROM), painful motion, or other ratable criteria.

The 25 May 2007 NARSUM examination, 6 months prior to separation, documented persistent pain rated 5/10 (no complaints of locking or subjective instability) that was aggravated by stairs and prolonged sitting, and that prohibited running and multiple general soldiering requirements.  The physical examination recorded the absence of tenderness or effusion and 4-plane stability to stress testing, without note of impingement.  The NARSUM examiner estimated flexion at 130 degrees (normal 140, 45 for minimum 10%) and noted “full” extension, without addressing painful motion.  Formal goniometric ROM measurements for the MEB were conducted by physical therapy (PT) a few days later; and, these were flexion to 150 degrees with 0 degrees extension (normal), specifying the absence of painful motion.

The 2 July 2007 VA Compensation and Pension (C&P) evaluation, 4 months before separation, documented pain rated 8/10 (specifically denying locking or subjective instability) aggravated by “any prolonged activities such as walking more than a mile or biking.”  The physical examination recorded a normal gait (no brace), the absence of tenderness or effusion, joint stability to stress testing, and negative signs of impingement (locking).  Goniometric ROM measurements were flexion to 135 degrees with 0 degrees extension, specifying painful motion but no ROM degradation with repetition.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB’s 0% rating under code 5099-5003 (analogous to degenerative arthritis) cited the absence of “ratable limitation of motion” without comment regarding painful motion.  The VA‘s 10% rating under code 5260 (limitation of flexion) was based on the C&P evidence and cited painful motion.  There was no evidence for compensable ROM limitation, persistent effusion and locking, instability, or fracture with nonunion or malunion to support the minimum 10% rating under any applicable code.  The panel deliberated, however, whether there was satisfactory evidence of painful motion in support of a minimum 10% rating IAW VASRD §4.59.  Although the MEB PT examiner specified the absence of painful motion, it was not addressed in the rest of the service evidence; and, the C&P examination, more temporally probative than any other evidence, documented the presence of painful motion.  Members therefore agreed that reasonable doubt favored concession of §4.59.  After due deliberation, considering all of the evidence and conceding VASRD §4.3 (reasonable doubt), the panel recommends a 10% rating for the left knee condition under code 5014 (osteomalacia [similar to chondromalacia], defaulting to criteria of 5003).

BOARD FINDINGS:  In the matter of the left knee condition, the panel unanimously recommends a disability rating of 10%, coded 5014 IAW VASRD §4.71a.  There are no other conditions within the panel’s scope of review for consideration.

The panel recommends that the CI’s prior determination be modified as follows, effective as of the date of his prior medical separation:  

CONDITION	VASRD CODE	PERMANENT RATING	
Chondromalacia with Surgical Residuals, Left Knee	5014	10% 	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20160519, with attachments
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

AR20170015456, XXXXXXXXXXXXXXXXXXX

XXXXXXXXXXXXXXXXXXX

Dear XXXXXXXXXXXXXXXXXXX:

	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,	
Enclosure