RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2017-01815
BRANCH OF SERVICE:  army	SEPARATION DATE:  20070827

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E4, Counter-Intelligence Agent, medically separated for “mild early chondromalacia, left knee” with a disability rating of 0%.  

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 - 20070514	VARD - 20080428	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Mild Early Chondromalacia, Left Knee	5099-5003	0%	Degenerative Joint Disease of the Left Knee	5003	10%	20070912	
Spondylolysis (Lumbar)	Not Unfitting	Spondylolysis 	5239	10%	20070912	
Left Ankle Fracture	Not Unfitting	Degenerative Joint Disease of the Left Ankle	5003	NSC	20070912	
Mild Pes Planus	Not Unfitting	Bilateral Flat Feet	5276	NSC	20070912	
COMBINED RATING:  0%	COMBINED RATING OF ALL VA CONDITIONS:  20%	

ANALYSIS SUMMARY:  

Mild Early Chondromalacia, Left Knee.  According to the service treatment record and MEB narrative summary (NARSUM), the CI underwent a pre-service left knee arthroscopy in February 2002 with partial meniscectomy.  He enlisted on 24 November 2004 and did well until he twisted his knee while playing basketball and underwent a partial lateral meniscectomy in June 2006.  Radiographs on 15 December 2006 showed degenerative changes and a small joint effusion.  

At the 26 December 2006 orthopedic consultation, 8 months prior to separation, the CI complained of pain located over the lateral aspect of the left knee without radiation, exacerbated with running, lateral movements, and jumping.  He denied mechanical symptoms, but complained of subjective instability.  On examination, gait was normal.  There was no quadriceps atrophy, crepitus, effusion, swelling, or joint line tenderness (medial or lateral).  Range of motion (ROM) was 0-130 degrees (normal 0-140).  Provocative tests to assess ligamentous instability and meniscal pathology were all negative.  

During the 28 March 2007 MEB examination (recorded on DD Forms 2807-1 and 2808), 5 months prior to separation, the CI complained of left knee locking and swelling that prevented running.  Physical examination of the bilateral knees showed full non-tender ROM without effusion, crepitus, joint line tenderness, or ligamentous instability.  Provocative testing to elicit patellar or meniscal pathology was negative.  

The 29 March 2007 MEB NARSUM examination, 5 months prior to separation, noted complaints of episodes of locking with physical activity.  “MRI revealed no gross abnormalities particularly no obvious meniscal tears.”  Physical examination showed a normal gait and full ROM with no atrophy, effusion, or patellar abnormalities.  Provocative testing to elicit ligamentous instability or meniscal pathology was negative.  The 1 May 2007 physical therapy ROM examination, 4 months prior to separation, showed extension of 0 degrees (normal) and flexion of 130 degrees (normal 140), after repetition.  The examiner noted that the limitation was due to mechanical limitation from muscle contracture or internal derangement and not pain, although passive ROM was greater than active ROM.  Provocative testing to elicit anterior cruciate ligament pathology was negative.  

At the 12 September 2007 VA Compensation and Pension (C&P) examination, 1 month after separation, the CI reported weekly locking episodes and that he was only able to stand for 15-30 minutes or walk up to a quarter mile.  During flares of left knee pain he was unable to run, exercise, or go up and down stairs.  Physical examination showed a normal gait with no knee instability, but there was crepitus and grinding noted in his left knee.  ROM testing showed extension of 0 degrees and flexion of 130 degrees.  The examiner noted there was pain that started and stopped at 130 degrees.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the left knee condition 0%, coded 5099-5003 (analogous to degenerative arthritis), citing normal ROMs without any atrophy or ligamentous laxity, but with complaints of locking.  The VA rated the left knee condition 10%, coded 5003, based on the C&P examination, citing painful or limited motion of a major joint or group of minor joints.  

There was no limitation of flexion or extension that supported a rating under the VASRD diagnostic codes for limitation of motion (5260 or 5261).  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).  However, the 5259 code (cartilage, semilunar, removal of, symptomatic) was applicable in this case, and provided a route to a 10% rating.  There was insufficient evidence of frequent episodes of “locking,” pain, and effusion into the joint for higher rating under code 5258 (cartilage, semilunar, dislocated).  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 left knee condition, coded 5003-5259.  

Contended PEB Conditions:  Spondylolysis, Left Ankle Fracture, and Mild Pes Planus.  The panel’s main charge is to assess the fairness of the PEB’s determination that the contended conditions were not unfitting.  None of the conditions were profiled, implicated in the commander’s statement, nor 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 that 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 condition, the panel recommends a disability rating of 10%, coded 5003-5259 IAW VASRD §4.71a.  In the matter of the contended spondylolysis, left ankle fracture, and mild pes planus 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.  

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

CONDITION	VASRD CODE	PERMANENT RATING	
Mild Early Chondromalacia, Left Knee	5003-5259	10%	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20170309, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Record

AR20180005848, 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 and to the counsel you listed on your application, XXXXXXXXXXXXXXXXXX

Sincerely,					      
Enclosure