RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXX	CASE:  PD-2016-01264
BRANCH OF SERVICE:  ARMY 	SEPARATION DATE:  20040117

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E4, Medical Specialist, medically separated for “chondromalacia patella of the left knee” with a disability rating of 0%.  

CI CONTENTION:  “Diagnosis of Dysthymic disorder changed to PTSD.”  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 - 20030926	VARD - 20040217	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chondromalacia Patella of the Left Knee	5099-5003	0%	Left Knee Chondromalacia Patella	5099-5014	10%	20031211	
COMBINED RATING:  0%	COMBINED RATING OF ALL VA CONDITIONS:  40%	

ANALYSIS SUMMARY:  

Chondromalacia Patella of the Left Knee.  According to the service treatment record and Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s left knee condition began about 6 years before his MEB without specific injury.  Radiographic studies on 10 December 2002 showed no evidence of fracture, dislocation, or other abnormality and no joint effusion or significant arthritic change.  At a 30 January 2003 orthopedic appointment, he reported pain behind the left kneecap, increasing with activity, but with no instability, locking, or swelling and occasional popping and catching.  On examination, he had full range of motion (ROM), pain with prolonged flexion, no ligamentous instability or laxity, and a positive Apley grind test (signifying possible meniscus damage).  A follow-up MRI on 28 February 2003 showed a normal knee, with intact cruciate and collateral ligaments and no evidence of meniscal tear or significant joint effusion and no loose bodies.  

The 11 March 2003 MEB NARSUM examination, 10 months prior to separation, noted CI complaints of intermittent and moderate left knee pain that prevented him from squatting and completing the Army physical fitness test run.  He took pain medication, denied swelling or locking, but felt his knee was unstable and wore a neoprene brace.  Physical examination showed a normal gait without assistive devices.  ROM was mildly limited with flexion to 130 degrees (normal 140) and extension to 0 degrees (normal).  There was no effusion, but crepitus with motion was noted, as well as patella tenderness both medially and laterally.  The examiner did not comment on pain with motion.  On 16 June 2003, the CI was evaluated for complaints of his right knee giving out and falling with injury to his right hand, left knee, and left ribs.  

At the 11 December 2003 VA Compensation and Pension (C&P) evaluation, 1 month before separation, the CI reported stiffness after prolonged sitting or standing, and pain when climbing and descending stairs.  Physical examination showed full ROM with a gait favoring both knees.  There was no ligamentous instability or laxity, or signs of meniscal problems.  The examiner’s functional assessment indicated “increased pain with weight bearing activity.  No decrease in range of motion.”  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the left knee condition 0%, analogously coded 5099-5003 (arthritis, degenerative), citing the US Army Physical Disability Agency pain policy and a normal physical examination except for some patellar tenderness.  The VA rated the left knee condition 10%, analogously coded 5099-5014 (osteomalacia), based on the C&P examination 1 month before separation, citing patellar tenderness, crepitus with motion, and complaints of pain with weight bearing.  

The panel agreed that the VA examination was closest to separation and had the highest probative value for rating at separation.  There was no limitation of flexion or extension that supported a rating under the VASRD diagnostic codes for limitation of motion (5260 or 5261).  examinations proximate to separation did not show the presence of ligamentous instability or laxity (5257), and 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 the respective 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).  However, there was evidence of painful motion with functional loss supporting a 10% rating (based on §4.59, §4.40 and §4.45).  After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the panel recommends a disability rating of 10% for the left knee condition, coded 5099-5003.  

BOARD FINDINGS:  In the matter of the left knee condition, the panel unanimously recommends a disability rating of 10%, coded 5099-5003 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 the prior medical separation:  

CONDITION	VASRD CODE	PERMANENT RATING	
Chondromalacia Patella of the Left Knee	5099-5003	10%	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20160928, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

AR20170019441, 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