RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2017-03555
BRANCH OF SERVICE:  Army	SEPARATION DATE:  20091215

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E4, Petroleum Supply Specialist, medically separated for “chronic right knee pain with chondromalacia patella tendonitis” and “chronic left knee pain with chondromalacia patella tendonitis,” rated 10% each, with a combined disability rating of 20%.

CI CONTENTION:  Requested review of back condition. 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 - 20090901	VARD - 20100210	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Right Knee Pain…	5099-5014	10%	Right Chondromalacia Patella with Tendinopathy	5014-5260	10%	20090416	
Chronic Left Knee Pain… 	5024	10%	Left Knee Patellar Tendinopathy	5024-5260	10%	20090416	
Mid Back Pain	Not Unfitting	Lumbar Spondylosis with Compression Fracture at L4	5235-5239	10%	20090416	
COMBINED RATING:  20%	COMBINED RATING OF ALL VA CONDITIONS:  80%	

ANALYSIS SUMMARY:

Chronic Right Knee Pain.  According to the service treatment record (STR) and MEB narrative summary (NARSUM), the CI’s right knee condition began in March 2008 after completing advanced individual training, and was treated with medication and a 2-week profile for no running.  He deployed with no problems and restarted physical therapy (PT) upon his return.  An MRI on 29 October 2008 showed chondromalacia patella, and surgery was not recommended.  
 
The 8 May 2009 MEB NARSUM examination, 7 months prior to separation, noted CI complaints of right knee pain.  Physical examination showed knee tenderness, minimal swelling, positive patellar grind, and negative instability testing.  Range of motion (ROM) testing was scheduled to be performed by the VA under the Pilot Disability Evaluation System (DES).

During the 16 April 2009 VA Compensation and Pension (C&P) examination, 8 months before separation, the CI reported right knee pain.  Physical examination revealed knee effusion and patellar tendon tenderness but no edema, weakness, redness, heat, guarded movement, subluxation, locking, genu recurvatum (hyperextension) or crepitus.  Right knee flexion was 90 degrees (normal 140) and extension was 0 degrees (normal).  Repetitive ROM showed limited flexion to 85 degrees due to pain.  Neurological, motor strength and deep tendon reflects were within normal limits.  A right knee MRI and X-ray were also normal.

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the right knee condition 10%, analogously coded 5099-5014 (osteomalacia), citing limitation of motion.  The VA also rated the right knee condition 10%, dual coded 5014-5260 (osteomalacia-leg, limitation of flexion), based on the C&P examination, citing painful ROM.  Members agreed there was no evidence of limitation of flexion or extension (5260 or 5261) or dislocated meniscus/loose body causing frequent locking with recurrent effusions (5258) to support a rating higher than 10%.  Additionally, there was no history of surgery to remove a meniscus (5259), and no fracture or knee impairment related to the femur or tibia (5255, 5262) to support ratings under those respective codes.  After due deliberation, considering all 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.

Chronic Left Knee Pain.  According to the STR and MEB NARSUM, the CI’s left knee condition began approximately in August 2008 without trauma.  Knee X-rays were normal and surgery was not indicated.  The MEB NARSUM examination noted CI complaints of left knee pain, and the examiner documented left knee tenderness at the tibial plateau and patella, crepitus, patellar grind, and slight swelling; instability testing was negative.  
	
At the C&P examination, the CI reported constant left knee pain with weakness, swelling and giving way.  Physical examination showed normal posture and gait with effusion and patellar tendon tenderness, but no signs of edema, weakness, redness, heat, or guarding movements; instability tests were negative.  There was also no “locking” pain, genu recurvatum or crepitus.  Flexion was to 95 degrees and extension to 0 degrees.  Repetitive ROM limited flexion to 93 degrees due to pain.  Neurological, motor strength and deep tendon reflexes were normal.

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the left knee condition 10%, coded 5024 (tenosynovitis), citing limitation of ROM.  The VA also rated the left knee condition 10%, dual coded 5024-5260, based on the C&P examination, citing painful ROM.  Members agreed there was no evidence of limitation of flexion or extension (5260 or 5261) or dislocated meniscus/loose body causing frequent locking with recurrent effusions (5258) to support a rating higher than 10%.  Additionally, there was no history of surgery to remove a meniscus (5259), and no fracture or knee impairment related to the femur or tibia (5255, 5262) to support ratings under those respective codes.  After due deliberation, considering all 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 condition.

Contended PEB Condition:  Mid Back Pain.  The panel’s main charge is to assess the fairness of the PEB determination that the contended condition was not unfitting.  The contended condition was not profiled, implicated in the commander’s statement or judged to fail retention standards.  There was no performance-based evidence from the record that the condition 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 chronic right and left knee pain conditions and IAW VASRD §4.71, the panel recommends no change in the PEB adjudications for either.  In the matter of the contended mid back pain condition, the panel unanimously agrees it cannot recommend it for additional disability rating.  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 20170406, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Record

[AR Number], 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