[AR Number], XXXXXXXXXX. 

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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.

Enclosure

RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME: XXXXXXXXXX.	CASE:  PD-2017-04634
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20080723

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E6, Air Defense Command Control Communications Computers and Intelligence Tactical Operations Center Enhanced Operator/Maintainer, medically separated for “right chondromalacia patella” and “left chondromalacia patella,” rated 10% each, with a combined disability rating of 20%.   

CI CONTENTION:  Review requested of an additional condition not identified by the Medical Evaluation Board (MEB) and Physical Evaluation Board (PEB).  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 PEB to be unfitting for continued military service, and when specifically requested by the CI, those conditions identified by the 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 - 20080424	VARD - 20080724	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Right Chondromalacia Patella	5099-5003	10%	Osteoarthritis, Right Knee	5260-5010	10%	20080426	
Left Chondromalacia Patella	5099-5003	10%	Osteoarthritis, Left Knee	5260-5010	10%		
COMBINED RATING:  20%	COMBINED RATING OF ALL VA CONDITIONS:  60%	

ANALYSIS SUMMARY:  

Right and Left Knee Chondromalacia Patella.  Although the right knees and left knees were separately rated, the conditions are presented together because of dual onset and similarity of symptoms and treatment.  According to the service treatment record and MEB narrative summary (NARSUM), the CI’s bilateral knee condition began in early 2006 without specific incident or trauma noted.  Radiographic studies of both knees were normal.  
At the 25 February 2008 orthopedic clinic appointment, 5 months prior to separation, the CI complained of bilateral knee pain aggravated by weight bearing.  Physical examination revealed bilateral tenderness and swelling, but no instability.  Although knee range of motion (ROM) was normal, pain was elicited by movement in both knees.  Bilateral knee X-rays were normal.  

During the 26 March 2008 MEB examination (recorded on DD Forms 2807-1 and 2808), 4 months prior to separation, the CI reported constant aching of the knees, with pain on climbing up and down stairs, and stiffness while sitting.  The ROM evaluation showed bilateral flexion of 110 degrees (normal 140), and extension of 0 degrees (normal), with right patella crepitus.  On examination, there was mild bilateral knee tenderness and positive grind tests, but no effusions.  Provocative testing to elicit meniscal pathology or ligamentous instability were negative. The MEB NARSUM examination, on the same day, noted complaints of daily bilateral knee pain, rated at 4/10, due to prolonged walking or sitting, or high impact activities such as running, kneeling or squatting.  Physical examination noted a normal gait, but the CI complained of bilateral knee pain in the lateral aspects of both knees.  With the exception of pain on flexion, all other findings were the same as the MEB examination.  

At the 26 April 2008 VA Compensation and Pension (C&P) examination, 3 months before separation, the CI reported bilateral knee pain, rated at 7/10, with stiffness, lack of endurance, aching and burning due to physical activity and weather.  He was unable to run or jump and was limited in his ability to walk, sit or stand.  Physical examination showed a normal gait, and neurological findings were within normal limits.  The ROM evaluation, after repetition, was 113 degrees of flexion on the right, with pain, and 107 degrees on the left, with pain.  Extension was normal for both knees.  Ligament tests were also normal bilaterally.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB separately rated the right and left knees at 10% each, analogously coded 5099-5003 (arthritis, degenerative), citing painful motion.  The VA also separately rated the right and left knees at 10% each, but coded 5260-5010 (limitation of leg flexion due to traumatic arthritis), based on the C&P examination, citing painful limited motion and X-ray evidence of degenerative changes in both knees.  Members noted there was no limitation of flexion or extension which supported a rating under diagnostic codes 5260 or 5261 for either knee.  However, there was evidence of bilateral painful motion with functional loss supporting 10% ratings for each knee (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) for either knee, or history of surgery to remove a meniscus (5259) for either knee to support a rating under those codes.   Additionally, 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) for either leg.  There was therefore no VASRD §4.71a rating higher than the 10% for each knee as 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 either the right or left knee conditions.  

BOARD FINDINGS:  In the matter of the right and left knee chondromalacia patella 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: