RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXX	CASE:  PD-2017-03206
BRANCH OF SERVICE:  Air Force 	SEPARATION DATE:  20060512

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects this covered individual (CI) was an E5, Vehicle and Vehicular Equipment Maintenance Craftsman, medically separated for “right patellar chondromalacia” with a disability rating of 10%. 

CI CONTENTION:  “Was not chronic knee pain as listed, it is chondromalacia patellae, grade 4, which is caused by a blow to the knee.”  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 - 20060307	VARD - 20070228	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Right Patellar Chondromalacia	5099-5003	10%	Right Chondromalacia Patella	5099-5014	10%	STR	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  10%	

ANALYSIS SUMMARY:  

Right Patellar Chondromalacia.  According to the service treatment record (STR) and MEB narrative summary (NARSUM), the CI underwent five arthroscopic knee surgeries, the first of which was in 1993 for repair of a meniscus and thereafter for cruciate ligament repairs.  An MRI of the right knee in October 2003 showed chondromalacia of the trochlea and medial femoral condyle and some possible laxity of the posterior cruciate ligament.  An MRI dated 30 September 2005 showed a tear of the medial meniscus at the posterior horn and a minimal effusion.  On 19 October 2005 at surgery, excessive synovial fibrillated tissue was shaved around the medial compartment and chondromalacia of the medial femoral cartilage was debrided.  An orthopedic examination dated 15 December 2005 recorded no swelling, full range of motion (ROM) and slight tenderness of the medial joint line.  The CI received Hyalgan (hyaluronate) injections on 20 and 27 December 2005, both times of which the CI had a full ROM of the right knee without laxity or instability and minimal joint line tenderness.  He had one additional Hyalgan injection on 10 January 2006, but still had marked pain with a lot of walking.  

The 17 January 2006 MEB NARSUM examination, 4 months prior to separation, noted the complaint of chronic right knee pain.  Physical examination showed normal gait and posture and “almost full ROM” with slight swelling.  There was no VA Compensation and Pension (C&P) examination proximate to separation; however, at the 21 July 2006 VA primary care clinic examination, 2 months after separation, the CI reported arthralgias of the right knee and a slightly decreased ROM.  Physical examination showed no redness, warmth, swelling or localized tenderness.  There was crepitus (grinding sensation) with flexion and extension without pain.  The joint appeared stable laterally and medially. 

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the right knee condition 10%, analogously coded 5099-5003 (arthritis, degenerative).  The VA also rated the right knee condition 10%, analogously coded 5099-5014 (osteomalacia), based on the STR, citing painful motion and crepitus with flexion of the knee.  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).  There was no history or evidence of dislocated meniscus or loose body causing frequent locking with recurrent effusions (5258) to support a rating under that code. The 5259 code (cartilage, semilunar, removal of, symptomatic) was applicable in this case, but the maximum 10% rating under that code provided no benefit to the CI.  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).  Therefore, there was no VASRD §4.71a rating higher than the 10% adjudicated by the PEB under any applicable code.  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 right knee condition.  

BOARD FINDINGS:  In the matter of the right 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:

SAF/MRB

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Dear XXXXXXXXXX:

		Reference your application submitted under the provisions of DoDI 6040.44 (Section 1554, 10 USC), PDBR Case Number PD-2017-03206.

After careful consideration of your application and treatment records, the Physical Disability Board of Review determined that the rating assigned at the time of final disposition of your disability evaluation system processing was appropriate.  Accordingly, the Board recommended no re-characterization or modification of your separation.

I have carefully reviewed the evidence of record and the recommendation of the Board.  I concur with that finding and their conclusion that re-characterization of your separation is not warranted.  Accordingly, I accept their recommendation that your application be denied.