RECORD OF PROCEEDINGS PHYSICAL DISABILITY BOARD OF REVIEW
NAME:  XXXXXXXXXXXXXXXXXXXXXXX	CASE: PD-2017-02409
BRANCH OF SERVICE: ARMY	SEPARATION DATE: 20080806

SUMMARY OF CASE: Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E4, Heavy Construction Equipment Operator, medically separated for “right knee strain injury and chondromalacia” and “left knee strain injury and chondromalacia,” rated 10% each, with a combined disability rating of 20%.

CI CONTENTION:  VA also rated sleep apnea.  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 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 - 20080613	VARD - 20090122	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Right Knee Strain Injury and Chondromalacia	5099-5003	10%	Right Knee Patellar Chondromalacia	5024-5260	10%	20081124	
Left Knee Strain Injury and Chondromalacia	5099-5003	10%	Left Knee Patellar Chondromalacia	5024-5260	10%	20081124	
COMBINED RATING: 20%	COMBINED RATING OF ALL VA CONDITIONS: 50%	

ANALYSIS SUMMARY:

Right and Left Knee Strain Injury and Chondromalacia. The evidence for the right and left knee conditions is presented collectively, with attendant separate rating recommendations. According to the service treatment record (STR) and MEB narrative summary (NARSUM), the CI’s right and left knee pain worsened after returning from deployment in late 2006. There was no history of direct trauma, but rather a history of overuse activities while working around and driving heavy equipment. Treatment included activity restrictions, physical therapy (PT), medication and orthotics. Bilateral knee MRIs revealed “unremarkable” findings on the left and “moderate to severe cartilage loss” on the right.

The 30 April 2008 MEB PT examination, 3 months prior to separation, noted complaints of chondromalacia in both knees. After repetition, goniometric range of motion (ROM) measurements revealed right knee flexion to 110 degrees (normal 140) and extension to 0

degrees (normal); and left knee flexion to 125 degrees and extension to 0 degrees, with pain limiting motion in both knees. At the 9 May 2008 MEB NARSUM examination, the CI stated that his knees “hurt all the time.” The examiner noted painful bilateral knee motion, and cited the MEB PT ROM measurements.  There was also knee tenderness, but no joint instability.

At the 24 November 2008 VA Compensation and Pension (C&P) examination, 4 months prior to separation, the CI endorsed daily bilateral knee pain with flare-ups after prolonged sitting. Physical examination showed a normal gait with negative ligament and meniscal testing. Bilateral knee flexion was to 120 degrees and extension to 0 degrees, with painful motion but no ROM loss following repetitive motion.

The panel directed attention to its rating recommendation based on the above evidence. The PEB rated both knee conditions 10% each, both analogously coded 5099-5003 (degenerative arthritis), citing painful ROM. The VA also rated both knee conditions 10%, both dual coded 5025- 5260 (tenosynovitis-leg, limitation of flexion) based on the C&P examination, citing painful motion. Panel members agreed that while there was no compensable limitation of flexion or extension (5260 or 5261) for either knee, there was satisfactory STR and VA evidence of bilateral knee painful motion with functional loss to support a 10% rating for each knee IAW §4.59, §4.40 and §4.45. There was no evidence of dislocated meniscus or loose body causing frequent locking with recurrent effusions (5258); history of cartilage (meniscus) “removal” surgery (5259); or fracture, nonunion or malunion of the femur or tibia causing a knee impairment (5255, 5262) to support a rating for either knee under those codes. After due deliberation, considering all the evidence and mindful of VASRD §4.3 (reasonable doubt), the panel concluded there was insufficient cause to recommends a change in the PEB adjudication for either the right or left knee conditions.

BOARD FINDINGS: In the matter of the right and left knee conditions 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 20170304, w/atchs Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs

	

AR20190013199, 

Dear XXXXXXXXXXXXXXX;

	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