RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX 	CASE:  PD-2017-04222
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20090227

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E4, Infantryman, medically separated for “bilateral chondromalacia patellae” with a disability rating of 20%.  

CI CONTENTION:  Review all conditions.  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 - 20081216	VARD - 20100419	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Bilateral Chondromalacia Patellae	5099-5003	20%	Residuals Left Knee Sprain	5260-5010 	10%	20100115	
			Right Knee Sprain and Chondromalacia	5299-5260	NSC	20100115	
Low Back Pain	Not Unfitting	Facet Joint Arthropathy  	5242	0%	20100115	
Bilateral Wrist Pain	Not Unfitting	Bilateral Carpel Tunnel Syndrome	8599-8515	NSC	20100115	
Left Testicle  Spermatocele and Hydrocele	Not Unfitting	Benign Cyst Right Epididymal Hydrocele without Residuals, Small Right Sided Hydrocele without Residuals	7599-7525	0%	20100115	
		Benign Cyst Left Epididymal  Hydrocele without Residuals	7599-7525	0%	20100115	
Bilateral Tinnitus	Not Unfitting	Tinnitus	6260	10%	20100115	
Exercise-Induced Shortness of Breathe	Not Unfitting	Exercise-Induced Shortness of Breath 	6699-6600	NSC	20100115	
COMBINED RATING:  20%	COMBINED RATING OF ALL VA CONDITIONS:  20% 	

ANALYSIS SUMMARY:  

Bilateral Chondromalacia Patellae.  According to the service treatment record and MEB narrative summary (NARSUM), the CI experienced an insidious onset of bilateral kneecap pain in July 2007.  Knee X-rays did not show any bony fracture or tumors, and joint spaces were well maintained.  A left knee MRI in February 2008 showed a small joint effusion with normal ligaments, and a right knee MRI in October 2008 showed a possible small tear of the medial meniscus, but was otherwise unremarkable.  

The 28 October 2008 MEB NARSUM examination, 4 months prior to separation, noted complaints of knee pain.  The CI rated his pain on a good day at 2/10, but on a bad day, his pain was at 6-7/10, and he could not go up or down stairs.  Physical examination showed a normal gait, but effusions and crepitus of both knees.  Following repetitive movement, knee range of motion (ROM) was 0-128 degrees (normal 0-140) on the left, and 0-116 degrees on the right.  

At the 15 January 2010 VA Compensation and Pension (C&P) examination, 11 months after separation, the CI reported knee pain when lifting and loading too much weight, and that he could not run or squat.  Physical examination showed a normal gait and bilateral knee ROM from 0-140 degrees, after repetition and with painful motion.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the bilateral knee condition 20%, coded 5299-5003, but indicated the combined 20% rating reflected a 10% rating for each unfitting knee, citing joint tenderness and motion slightly limited by pain.  The VA rated the left knee condition 10%, analogously coded 5260-5010 (leg, limitation of flexion of–traumatic arthritis), citing painful or limited motion of a major joint and did not service connect the right knee, citing no permanent residual or chronic disability, both based on the C&P examination.  Panel members agreed that there was no compensable limitation of flexion or extension (5260 or 5261) for either knee, however, there was evidence of painful motion with functional loss supporting a 10% rating for each knee (based on §4.59, §4.40 and §4.45).  Additionally, there was no history or evidence of dislocated meniscus or loose body causing frequent locking with recurrent effusions (5258); history of surgery to remove a meniscus (5259) to support a rating under those codes; and 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).  There was therefore no VASRD §4.71a rating higher than the 10% (for each knee) 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 bilateral knee condition.  

Contended PEB Conditions:  Low Back Pain, Bilateral Wrist Pain, Left Testicle Spermatocele and Hydrocele, Bilateral Tinnitus, Exercise-Induced Shortness of Breath.  The panel’s main charge is to assess the fairness of the PEB determination that the contended conditions were not unfitting.  None of the conditions were profiled or implicated in the commander’s statement, and none failed retention standards.  There was no performance-based evidence from the record that any of the conditions 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 any of the contended conditions, so no additional disability ratings are recommended.  

BOARD FINDINGS:  In the matter of the bilateral knee condition and IAW VASRD §4.71a, the panel recommends no change in the PEB adjudication.  In the matter of the contended low back pain, bilateral wrist pain, left testicle spermatocele and hydrocele, bilateral tinnitus, and exercise-induced shortness of breath, the panel recommends no change from the PEB determinations 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.  

The following documentary evidence was considered:

	PD-2017-04222

AR20190012132, XXXXXXXXXXXXXXXXXXXXXXX 

Dear XXXXXXXXXXXXXXXXX

	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.

	PD-2017-04222