RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX  	CASE:  PD-2017-03955
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20090119

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E4, Combat Engineer, medically separated for “left knee chondromalacia” with a disability rating of 10%.  

CI CONTENTION:  “I was also awarded via the VA a rating of 30% for PTSD, as well as a rating for both knees, the MEB only considered one.”  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 - 20081126	VARD - 20090925	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Left Knee Chondromalacia	5099-5003	10%	Left Knee Patellofemoral Syndrome	5299-5262	10%	20090916	
Right Knee Pain	Not Unfitting	Right Knee Patellofemoral Syndrome	5299-5262	10%		
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  50%	

ANALYSIS SUMMARY:  

Left Knee Chondromalacia.  According to the service treatment record and MEB narrative summary (NARSUM), the CI’s left knee condition began in 2006 after constant pressure and usage while standing 8 to 12 hours per day.  The 22 September 2008 MEB NARSUM examination, 4 months prior to separation, noted complaints of constant pain in the patellar region of the left knee.  Physical examination showed tenderness over the infrapatellar and suprapatellar tendon.   The patellar grind test was positive, but other provocative tests to elicit instability or meniscal pathology were negative.  Gait was normal with normal toe and heel walking.  No brace or assistive devices were used.  Bilateral knee range of motion (ROM) testing showed flexion of 124 degrees (normal 140) and extension of 4 degrees (normal 0).  

At the 16 September 2009 VA Compensation and Pension (C&P) examination, 8 months after separation, the CI reported flare-ups in his left knee about two or three times a week and usually lasting about half an hour.  Left knee ROM testing, following repetitive motion, showed flexion of 120 degrees and extension of 0 degrees with pain.  The examiner noted mild crepitus.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the left knee condition 10%, analogously coded 5099-5003 (degenerative arthritis), citing satisfactory evidence of painful motion with normal strength.  The VA also rated the left knee condition 10%, analogously coded 5299-5262 (tibia and fibula, impairment), based on the C&P examination, citing painful motion.  

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).  The panel considered other VASRD knee and analogous codes, but all were less applicable and not advantageous for rating.  There was 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 adjudication for the left knee condition.  

Contended PEB Conditions:  Right Knee Pain.  The panel’s main charge is to assess the fairness of the PEB determination that the contended condition was not unfitting.  The right knee condition was not profiled and did not 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.  Although the CI requested review of post-traumatic stress disorder (PTSD), the panel agreed the MEB and PEB did not identify PTSD as a potential disability, albeit anxiety disorder and adjustment disorder were identified.

BOARD FINDINGS:  In the matter of the left knee condition and IAW VASRD §4.71a, the panel recommends no change in the PEB adjudication.  In the matter of the contended right knee condition, the panel recommends no change from the PEB determination as not unfitting.  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. 

AR20190010924, XXXXXXXXXXXXXXXX 

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.