RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2016-01734
BRANCH OF SERVICE:  Army	SEPARATION DATE:  20030328

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E4, Infantryman, medically separated for “chronic right knee pain with chondromalacia” and “chronic left knee pain,” rated 10% and 0%, respectively, with a combined 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 Medical Evaluation Board (MEB), but determined by the PEB 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.  The panel’s authority is limited to assessing the fairness and accuracy of PEB rating determinations and recommending corrections when appropriate.  The panel’s assessment of the PEB rating determination is based on review of medical records and all available evidence relevant to application of the Veterans Affairs Schedule for Rating Disabilities (VASRD) standards for 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, which operates 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 disability at the time of separation.  

RATING COMPARISON:  

SERVICE PEB - 20030115	VARD - 20030311	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Right Knee Pain with Chondromalacia	5099-5003	10%	Right Knee Chondromalacia Patella Status Arthroscopic …	5259	10%	20030205	
Chronic Left Knee Pain	5099-5003	0%	Chronic Strain Left Knee	5299-5014	10%	20030205	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  60%	

ANALYSIS SUMMARY:  

Chronic Right Knee Pain, with Chondromalacia and Chronic Left Knee Pain.  According to the service treatment record and MEB narrative summary (NARSUM), the CI’s bilateral knee condition began in April 2001 when he felt consecutive pops in his knees during a 12-mile road march/run; initial X-rays showed normal knees.  The bilateral pain increased despite conservative treatment, and a right knee MRI in June 2001 revealed a medical meniscus tear.  The CI underwent a right knee meniscal repair in July 2001, with follow-up surgical debridement revealing chondromalacia.  The left knee had not improved during this time period despite conservative treatment.  Knee X-rays in January 2002 were unremarkable, but an MRI showed patellar chondromalacia and subchondral cyst of the medial tibial plateau without meniscal tear.  

During the 5 November 2002 MEB examination (recorded on DD Forms 2807-1 and 2808), 5 months prior to separation, physical examination revealed right knee pain with extension. The 4 December 2002 MEB NARSUM examination, 4 months before separation, noted CI complaints of constant bilateral knee pain, rated at 8/10, and worsened by activity.  Physical examination of both knees showed medial and lateral joint line tenderness and positive patellar grind, but no instability or laxity.  Physical therapy (PT) was referenced for a range of motion (ROM) study.  

There were two PT ROM evaluations dated 14 January 2003, 2 months prior to separation.  The Standard Form (SF) 600 entry documented passive left knee flexion to 110 degrees (normal 140), and right knee to 80 degrees; each knee lacked 10 degrees of extension (normal 0) and ROM was without pain.  The orthopedic consult entry documented passive flexion of the left knee to 130 degrees and the right knee to 120 degrees, both with pain; each knee had 3 degrees of hyperextension with pain.  

At the 5 February 2003 VA Compensation and Pension (C&P) examination, 1 month before separation, the CI reported moderate to severe pain during sleep requiring frequent leg movement.  His knees also locked daily with the right knee buckling while walking, and he had frequent cracking and popping with movement.  Physical examination showed flexion from 0-140 degrees; however, he could not squat past 45 degrees due to feelings of weakness behind both knees.  Moderate patellofemoral crepitus was present bilaterally, and there was increased pain with repetitive motion without deficits of strength, speed, coordination or fatigability, or change in ROM.  

The panel directed attention to its rating recommendations based on the above evidence.  The PEB rated the chronic right knee pain with chondromalacia 10%, analogously coded 5099-5003 (arthritis, degenerative), citing loss of joint motion, but no instability.  The VA rated the right knee chondromalacia patella condition 10%, coded 5259 (cartilage, semilunar, removal of symptomatic), based on the C&P examination, citing symptomatic meniscectomy residuals. Members noted that the SF 600 PT ROMs supported a 10% rating under code 5261 for extension limited to 10 degrees.  Alternatively, both the orthopedic PT ROM (cited by the PEB) and C&P examinations supported a 10% rating for painful motion (IAW VASRD §4.59).  All examinations proximate to separation supported a 10% rating analogous to 5259 for the persistence of pain after meniscal surgery.  There was no limitation of motion which supported a rating under the diagnostic codes for limitation of flexion (5260); no history of dislocated meniscus or loose body causing frequent locking with recurrent effusions (5258); and 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).  Any coding change would remain no higher than the 10% adjudicated by the PEB.  After due deliberation, considering all the evidence and mindful of VASRD §4.3 (reasonable doubt), the panel concluded there was insufficient cause to recommend a change in the PEB adjudication for the right knee condition.  

The PEB rated the chronic left knee pain 0%, analogously coded 5099-5003, citing moderate, intermittent pain with ROM from -3 to 130 degrees.  The VA rated the chronic left knee strain 10%, coded 5299-5014 (osteomalacia) based on the C&P examination, citing painful or limited motion of a major joint.  Members observed that the SF 600 PT ROMs supported a 10% rating under code 5261 for extension limited to 10 degrees.  Alternatively, both the orthopedic PT ROM (cited by the PEB) and C&P examinations supported a 10% rating for painful motion (IAW VASRD §4.59).  There was no limitation of motion which supported a rating under the diagnostic codes for limitation of flexion (5260); no history of dislocated meniscus or loose body causing frequent locking with recurrent effusions (5258) or history of surgery to remove a meniscus (5259); and 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).  The panel adjudged that the orthopedic PT and C&P examinations documented painful motion and functional loss supporting a 10% rating (based on §4.59, §4.40 and §4.45).  Coding analogous to 5003, 5014, or 5261 was considered, with coding of 5099-5003 being predominant.  After due deliberation, considering all 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 chronic right knee pain with chondromalacia and IAW VASRD §4.71, the panel recommends no change in the PEB adjudication.  In the matter of the chronic left knee pain and IAW VASRD §4.71, the panel recommends a disability rating of 10%, coded 5099-5003.  There are no other conditions within the panel’s scope of review for consideration.  

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

CONDITION	VASRD CODE	PERMANENT RATING	
Chronic Right Knee Pain with Chondromalacia	5099-5003	10%	
Chronic Left Knee Pain	5099-5003	10%	
COMBINED	20%	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20150625, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Record

AR20180014198, XXXXXXXXXXXXXXXXXX

XXXXXXXXXXXXXXXXXX

Dear XXXXXXXXXXXXXXXXXX

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