RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2017-00485
BRANCH OF SERVICE:  Army	SEPARATION DATE:  20070424

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

CI CONTENTION:  No specific contention was made.  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 - 20070119	VARD - 20070827	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chondromalacia Patella of Left Knee	5009-5003	0%	Degenerative Changes, Left Knee, S/P Multiple Surgeries	5010-5262	20%	20070330	
COMBINED RATING:  0%	COMBINED RATING OF ALL VA CONDITIONS:  70%	

ANALYSIS SUMMARY:  

Chondromalacia Patella of Left Knee.  According to the service treatment record and MEB narrative summary (NARSUM), the CI jammed her left knee in 2004 and then dislocated the knee cap in March 2005 which resulted in severe swelling requiring the knee to be drained.  She was placed in a knee brace and on crutches, and in May 2005, underwent an arthroscopic examination of her patella with chondroplasty of a medial patellar chondral injury and an open medial patellofemoral ligament repair.  She continued to have pain, and on 9 May 2006, she had an arthroscopic debridement of the patellofemoral joint with a lateral release; however, pain and instability persisted.  

The 29 September 2006 orthopedic consultation noted continued left knee patellofemoral pain after the CI’s surgeries.  Examination revealed a normal gait but marked left knee patellofemoral joint tenderness with an obvious clinical manifestation of patella alta.  There was marked crepitus without effusion, and marked tenderness at the tibial tubercle with an Osgood Schlatter’s ossicle (tibial bony abnormality) and inferior patellar pole ossicle.  The knee ligaments were otherwise stable.  The left patella tracked very abnormally (did not engage in the trochlea until beyond 75 degrees, and then only partially).  Diagnostic imaging showed both ossicles, marked patella alta, inferior patellar subchondral edema with marked thinning, and increased signal within the patella and tibial tubercle.  Given a guarded prognosis, an MEB was recommended.  Follow-up evaluation on 2 October 2006 provided a diagnosis of “joint instability knee/ patella/tibia fibula left patella alta with significant PFJ (patellofemoral joint) arthrosis and lateral patellar instability.”  

At the 30 November 2006 MEB NARSUM examination, 5 months prior to separation, the CI complained of stabbing pain behind the left knee cap radiating to the anterior aspect of the foot.  Subjective weakness and stiffness was reported after sitting more than 30 minutes along with instability 2-3 times per week.  Physical examination showed 1+ anterior cruciate ligament laxity with grinding as well as patellar looseness.  The knee was stable and non-tender, with left leg numbness in a stocking distribution up to the knee.  Range of motion (ROM) was flexion to 135 degrees (normal 140) and extension 0 degrees (normal).  

At the 30 March 2007 VA Compensation and Pension (C&P) examination, 1 month before separation, the CI reported the left knee gave way 2-3 times per month and locked if she lay for more than 4 hours.  She also described numbness along the lateral aspect of the knee and pain behind the knee cap; she did not wear a brace.  Physical examination showed an abnormal gait, with the left foot turned-in, making the CI unable to heel-toe walk.  There was tenderness along the medial aspect of the knee and Achilles tendon.  Left knee ROM was flexion of 130 degrees and extension of 0 degrees with no additional limitations in ROM or joint function following repetitions due to pain, fatigue, weakness, lack of endurance, or incoordination.  Tests for laxity and instability were negative (Lachman, drawer and McMurray test).  

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 “full, but painful” ROM.  The VA rated the left knee condition 20%, code 5010-5262 (arthritis, due to trauma-tibia and fibula impairment), based on the C&P examination, citing malunion of the tibia and fibula with moderate knee or ankle disability.  The diagnoses included left knee patellar malalignment, status post lateral release; and, left foot and ankle medial deviation inward with abnormal gait as a result of patellar surgery.  Members agreed there was no limitation of flexion or extension that supported ratings under VASRD diagnostic codes 5260 or 5261, and no history or evidence of dislocated meniscus or loose body causing frequent locking with recurrent effusions (5258).  Additionally there was no history of surgery to remove a meniscus for use of code 5259, and no fracture, non-union, or malunion of the femur to support consideration under code 5255.  However, all examinations proximate to separation documented significant patellar instability, pain on manipulation, and abnormal tender bony prominence of the tibial tuberosity for consideration of rating analogous to 5262 (tibia and fibula, impairment of).  The orthopedic and C&P examinations were the most detailed and had the highest probative value for rating.  The panel agreed that the CI’s left knee disability most nearly approximated the “moderate knee or ankle disability” (20%) criteria. After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the panel recommends a disability rating of 20% for the chondromalacia patella of the left knee condition, coded 5010-5262.  

BOARD FINDINGS:  In the matter of the chondromalacia patella of the left knee, the panel recommends a disability rating of 20%, coded 5010-5262 IAW VASRD §4.71a.  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	
Chondromalacia Patella of Left Knee	5010-5262	20%	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20170213, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Record

AR20180009191, 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