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Dear XXXXXXXXXX:

	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.

RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXX.	CASE:  PD-2017-03572
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20080222

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty  E6, Automated Logistical NCO, medically separated for “right knee chondromalacia” with a disability rating of 10%.  

CI CONTENTION:  “Arthritis Right 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 - 20090213	VARD - 20080505	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Right Knee Chondromalacia	5099-5003	10%	Degenerative Arthritis, Right Knee	5010	10%	20080205	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  60%	

ANALYSIS SUMMARY:  

Right Knee Chondromalacia.  According to the service treatment record and MEB narrative summary (NARSUM), the CI underwent right knee surgery in February 2006 with lateral release, resection of synovial plica, shaving chondroplasty and subchondral joint drilling.  Post-operative right knee radiographic studies demonstrated chondromalacia and degenerative changes.  However, orthopedics indicated there was no surgical solution.  

During the 27 December 2007 MEB examination (recorded on the MEB NARSUM and DD Forms 2807-1 and 2808), 2 months prior to separation, noted complaints of chronic daily 2/10 right knee pain at rest.  The pain increased to 5/10 with walking or prolonged standing and to 8/10 with running or jumping.  The CI also complained of right knee pain with squatting, bending or kneeling.  On examination, there was crepitus and a positive patellar grind test.  The goniometric range of motion (ROM) evaluation showed right knee flexion of 105 degrees (normal 140) and extension of 0 degrees (normal).  There was no report of painful motion and the knee was ligamentously stable.  

At the 5 February 2008 VA Compensation and Pension (C&P) examination, less than 1 month before separation, the CI reported 6/10 right knee pain, weakness, swelling and giving way.  The pain was elicited by activity and restricted running, kneeling and bending.  He denied stiffness, heat, redness, lack of endurance, locking, fatigability or dislocation.  Physical examination showed normal gait and posture.  There were no signs of edema, effusion, weakness, tenderness, redness, heat, subluxation, guarding of movement, locking pain, genu recurvatum or crepitus.  Stability tests were normal.  The ROM evaluation showed 130 degrees of flexion with pain and 0 degrees of extension.  Although the examiner noted the right knee was additionally limited after repetition due to pain, the limitation was 0 degrees.  The right knee was not additionally limited by fatigue, weakness, lack of endurance or incoordination after repetitive use.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the right knee condition 10%, analogously coded 5003 (degenerative arthritis), citing minor functional loss caused by pain from repeated use or flare-ups.  The VA also rated the right knee condition 10%, coded 5010 (traumatic arthritis), based on the C&P examination, citing painful or limited motion with consideration of Deluca.  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), or history of surgery to remove a meniscus (5259) to support a rating under those codes.  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).  No additional functional limitation was evidenced by the examinations.  There is therefore no VASRD §4.71a rating higher than the 10% adjudicated by the PEB under any applicable code.  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’s right knee adjudication.  

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.