RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2017-01465
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20090911

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E4, Human Intelligence Collector, medically separated for “chondromalacia of the left knee” with a 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 FPEB - 20090724	VARD - 20090915	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chondromalacia, Left Knee	5013	10%	Chondromalacia, Left Knee	5261-5013	10%	20090318	
Dyspepsia	Not Unfitting	Dyspepsia	7307	0%	20090324	
Insomnia	Not Unfitting	No VA Placement	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  30%	

ANALYSIS SUMMARY:  

Left Knee Chondromalacia.  According to the service treatment record and MEB narrative summary (NARSUM), the CI began experiencing increased knee pain during physical training and road marches in March 2007, and an MRI indicated intact ligaments and tendons, but evidence of patella degeneration consistent with chondromalacia patella.  In December 2008, the CI was deemed a non-surgical candidate, and despite extensive physical therapy and pain medications, his symptoms remained unrelieved.  

At the 18 March 2009 VA Compensation and Pension (C&P) examination, 6 months before separation, the CI reported chronic left knee pain, aggravated by prolonged standing, walking, squatting, kneeling and running.  He stated that while deployed he felt his left knee “pop” followed by pain and swelling.  The examiner noted the CI walked into the room wearing a large backpack and carrying a cane, which he did not need for ambulation; gait and posture were not characterized.  There was no localized tenderness, swelling, deformity, motor weakness, atrophy or instability, and “no sensory motor reflex deficits present.”  McMurray and Lachman tests as well as anterior-posterior drawer signs were negative.  Range of motion (ROM) showed flexion to 135 degrees (normal 140) and extension to 0 degrees (normal), with discomfort between 120 to 135 degrees of flexion.  

During a physical therapy evaluation on 13 May 2009, 4 months before separation, the CI complained of left knee pain for over a year.  Physical examination showed ROM within normal limits and negative instability tests.  

At the 24 June 2009 MEB NARSUM examination, 3 months prior to separation, the CI reported chronic, daily left knee pain rated at 5/10, and increasing to 7/10 with activity.  Physical examination demonstrated an antalgic gait, mild impairment while moving from the examination table to the chair, and cane assisted ambulation.  

The panel directed attention to its rating recommendation based on the above evidence.  The formal PEB rated the left knee chondromalacia 10%, coded 5013 (osteoporosis, with joint manifestations), citing the condition prevented performance of basic duties.  The VA rated the left knee chondromalacia 10%, analogously coded 5261-5013 (osteoporosis), based on the C&P examination, citing painful or limited motion of a major joint or group of minor joints.  Members noted there was no limitation of motion which supported a rating under the diagnostic codes for limitation of flexion or extension (5260, 5261).  However, there was evidence of painful motion with functional loss supporting a 10% rating (based on §4.59, §4.40 and §4.45) as adjudicated by the PEB.  The examinations proximate to separation did not demonstrate the presence of ligamentous instability or laxity (5257); a history of dislocated meniscus or loose body causing frequent locking with recurrent effusions (5258); or fracture, non-union, or malunion of the femur or tibia for knee impairment related to long bone conditions (5255, 5262).  There was therefore no rating higher than the 10% adjudicated by the PEB under any applicable code, and no grounds for additional rating based on the presence of instability.  After due deliberation, considering all of 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 left knee chondromalacia.  

Contended PEB Conditions:  Dyspepsia and Insomnia.  The panel’s main charge is to assess the fairness of the PEB determination that the contended conditions were not unfitting.  Only dyspepsia was profiled (P2), and neither of the conditions were implicated in the commander’s statement or judged to fail retention standards.  There was no performance-based evidence from the record that any of the conditions significantly interfered with satisfactory duty performance at separation.  After due deliberation, the panel concluded there was insufficient cause to recommend a change in the PEB fitness determination for any of the contended conditions, so no additional disability ratings are recommended.  

BOARD FINDINGS:  In the matter of the left knee chondromalacia and IAW VASRD §4.71, the panel recommends no change in the PEB adjudication.  In the matter of the contended dyspepsia and insomnia conditions, the panel recommends no change from the PEB determinations as not unfitting.  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 20170308, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Record

AR20180010084, 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