RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2017-01744
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20041022

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was a National Guard  E4, Military Police, medically separated for “chondromalacia patella” with a disability rating of 0%.   

CI CONTENTION:  “Right knee,” “diabetes,” and “keratoconus.”  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 - 20040830	VARD - 20041209	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chondromalacia Patella	5099-5003	0%	Chondromalacia, Right Knee	5260	10%	20041028	
Diabetes Mellitus	Not Unfitting 	Diabetes Mellitus	7913	20%		
Keratoconus		Keratoconus, Bilateral	6035	0%		
COMBINED RATING:  0%	COMBINED RATING OF ALL VA CONDITIONS:  50% 	

ANALYSIS SUMMARY:  

Chondromalacia Patella.  According to the service treatment record and MEB narrative summary (NARSUM), the CI underwent right knee surgery in May 2008 for reconstruction of his anterior cruciate ligament (ACL) and debridement of meniscal tears and loose bodies.  The CI reported post-operative stability in his knee, but increased pain.  Radiographic (X-ray) studies in October 2003 showed post ACL repair with mild decreased medial joint space.  At the time of the orthopedic sports clinic appointment on 14 November 2003, 11 months prior to separation, the CI reported right knee pain.  Physical examination showed global symbolic pain, negative valgus test, and range of motion (ROM) with flexion of 120 degrees (normal 140) and extension of 5 degrees (normal 0).  At the time of an orthopedic clinic appointment on 9 February 2004, 8 months prior to separation, physical examination showed a stable varus/valgus, negative Lachman’s, and negative anterior drawer test.  ROM measurements showed a flexion of 120 degrees and a normal extension of 0 degrees.  The examiner reported that the CI met retention standards and was fit for duty. 

During the 17 February 2004 MEB examination (recorded on DD Forms 2807-1 and 2808), 8 months prior to separation, the CI reported knee trouble.  Physical examination of the right knee showed no tenderness, joint instability, or crepitation.  At the time of an orthopedic clinic appointment on 19 May 2004, 5 months prior to separation, the CI reported knee pain.  Physical examination showed tenderness and pain throughout testing.  There was no edema, erythema, crepitus, or instability.  ROM measurements were reported as full.  The examiner reported that the knee was stable, but had severe degenerative joint disease.  

The 26 May 2004 orthopedic examination for the MEB NARSUM addendum, 5 months prior to separation, reported tenderness and pain with varus and valgus stress test.  There was approximately 1 cm of varus and valgus instability, positive McMurray’s test, and minimal effusion about the knee.  ROM measurements showed flexion of 115 degrees and a normal extension of 0 degrees.  

At the 29 July 2004 orthopedic examination for the MEB NARSUM addendum, 3 months prior to separation, the CI reported difficulty with his right knee.  Physical examination noted there was no effusion and ROM measurements showed a flexion of 125 degrees and a normal extension of 0 degrees.  Drawer test was negative and there was a trace Lachman test.  The CI was sore with pivot shift testing and with compression over the patellofemoral joint and anterolateral joint line.  There was visible mild atrophy of the vastus medialis portion of his right quadriceps. 

At the 28 October 2004 VA Compensation and Pension (C&P) examination, 6 days after separation, the CI reported constant pain in the right knee.  Physical examination showed there was a normal gait and no soft tissue swelling, effusion, or deformity.  There was tenderness and minimal crepitus during movements of the knee.  ROM measurements showed a flexion of 130 degrees and a normal extension of 0 degrees.  All movements of the knee were performed slowly and with guarding with pain at the end of flexion.  There was normal strength and anterior drawer test, McMurray’s test, and test for lateral instability were negative.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the right knee condition 0%, analogously coded 5003 (arthritis, degenerative), citing full ROM, no effusion in the knee, and a negative Lachman’s sign. The VA rated the right knee condition 10%, coded 5260 (leg, limitation of flexion), citing painful motion.  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).  The persistence of pain after meniscal surgery also warranted a 10% rating under the 5259 code (cartilage, semilunar, removal of symptomatic).  The evidence did not support a rating for dislocated meniscus or loose body causing frequent locking with recurrent effusions (5258).  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 therefore no VASRD §4.71a route to a rating higher than the 10%.  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 chondromalacia patella condition, coded 5099-5003.  

Contended PEB Conditions:  Diabetes Mellitus and Keratoconus.  The panel’s main charge is to assess the fairness of the PEB’s determination that the contended conditions were not unfitting.  The diabetes mellitus condition was profiled and judged to fail retention standards by the MEB.  However, the condition was not implicated in the commander’s statement.  The undated diabetes consult stated that the diabetes was well controlled and the CI had no diabetes related complications.  The keratoconus condition was not profiled, implicated in the commander’s statement, nor judged to fail retention standards. There was no performance-based evidence from the record that 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 the contended condition, so no additional disability rating is recommended.  

BOARD FINDINGS:  In the matter of the chondromalacia patella condition, the panel recommends a disability rating of 10%, coded 5099-5003 IAW VASRD §4.71a.  In the matter of the contended diabetes mellitus and keratoconus conditions, the panel recommends no change in the PEB adjudication.  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 the date of medical separation:  

CONDITION	VASRD CODE	PERMANENT RATING	
Chondromalacia Patella	5099-5003	10%	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20170224, w/attachments
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Record 

AR20180005844, 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