RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2017-00661
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20091117

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 “chondromalacia patellae, right knee” and “chondromalacia patella, left knee,” rated 0% each, with a combined disability rating of 0%.  

CI CONTENTION:  No specific contention 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 - 20090915	VARD - 20100125	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chondromalacia Patellae, Right Knee	5009-5014	0%	Chondromalacia Patella, Right Knee	5099-5014	0%	20090609	
Chondromalacia Patella, Left Knee	5009-5014	0%	Chondromalacia Patella, Left Knee	5009-5014	0%	20090609	
COMBINED RATING:  0%	COMBINED RATING OF ALL VA CONDITIONS:  10%	

ANALYSIS SUMMARY:  

Bilateral Knees.  According to the service treatment record and MEB narrative summary (NARSUM), the CI’s chondromalacia patellae (left knee and right knee) condition began 12 December 2006 without any significant trauma.  He was treated conservatively but was diagnosed with patellofemoral pain syndrome.  The CI reported bilateral knee pain in November 2007 after running with a backpack for 2 miles.  X-rays of the right knee in January 2009 showed no abnormality but X-rays of the left knee showed foreign body/shrapnel in the medial soft tissues adjacent to the proximal tibia.    Neuro-imaging of the right knee in March 2009 showed questionable chondromalacia along the medial patellar facet.  Due to shrapnel in the left leg, neuro-imaging of the left knee was not possible but the chondromalacia diagnosis was rendered.  The 12 May 2009 physical therapy (PT) examination of the right and left knees, measured by goniometer, showed no range of motion (ROM) limitations.  There was no muscle spasm, swelling, atrophy, deformity, or scarring.  Pain did not interfere with standing, sitting, or weight bearing of the lower extremity bilaterally.  

At the 9 June 2009 VA Compensation and Pension (C&P) examination, 6 months before separation, CI reported the knees were always painful, except when asleep.  The pain had become progressively worse.  He had taken Tylenol and Advil in the past, had various knee braces and physical therapy, all without effect.  He was not taking any medications.  The CI reported pain when exercising, ascending stairs, and with any impact activity.  Physical examination of the knees showed tenderness of the medial joint line bilaterally with no evidence of crepitation, masses, instability, clicks or snaps, or other abnormalities.  There was no evidence of painful motion.  Flexion was to 140 degrees (normal), and extension to 0 degrees (normal) bilaterally.  There was no evidence of ankyloses.  Physical examination of the left knee showed the same findings as the right knee with the exception of the presence of crepitation, clicks, or snaps.  

The 29 June 2009 MEB NARSUM examination, 5 months prior to separation, noted both knees were always painful, although he was taking no medications.  He denied any giving way, instability, locking, or joint swelling.  The pain had a mild effect on his ability to lift and carry, do chores, shop, exercise, and drive.  Physical examination referenced the 9 June findings of the VA examiner and the 12 May 2009 ROM measurements.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the chondromalacia patellae (right and left knee) condition 0% for each knee, analogously coded 5099-5014 (osteomalacia).  The VA also rated the chondromalacia patellae (right knee and left knee) condition 0% for each knee, also coded 5099-5014, based on the C&P examination, citing no evidence of painful or limited motion.  

The panel noted the absence of limitation of motion to support a rating under the diagnostic codes for limitation of flexion or extension (5260, 5261).  There was no history or evidence 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 that those codes.  There was no fracture, nonunion, or malunion of the femur or tibia to support consideration under the respective codes for knee impairment related to long bone conditions (5255, 5262).  There was no objective evidence of painful motion (4.59) to achieve a 10% rating.  There was therefore no VASRD §4.71a higher rating option than the 0% for the right knee and 0% for the left knee adjudicated by the PEB under any applicable code.  After due deliberation, considering all 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 and right knee conditions.  

BOARD FINDINGS:  In the matter of the right knee condition and IAW VASRD §4.71a, the panel recommends no change in the PEB adjudication.  In the matter of the left knee condition and IAW VASRD §4.71a, the panel recommends no change in the PEB adjudication.  There are no other conditions within the panel’s scope of review for consideration.  Therefore, the panel recommends 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 20170215, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Record 

AR20180007948, 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