RECORD OF PROCEEDINGS PHYSICAL DISABILITY BOARD OF REVIEW
NAME:  XXXXXXXXXX	CASE: PD-2017-04671
BRANCH OF SERVICE: AIR FORCE	SEPARATION DATE: 20090928

SUMMARY OF CASE: Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E5, Avionics Craftsman, medically separated for “left knee chondromalacia patella” with a disability rating of 10%.

CI CONTENTION: “The 10% rating granted seems minimal in light of this life changing injury sustained during my times as active duty” 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 – 20090619	VARD – 20091026	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Left Knee Chondromalacia Patella	5099-5014	10%	Status Post Cartilage Removal in Left Knee	5299-5259	10%	20090714	
COMBINED RATING: 10%	COMBINED RATING OF ALL VA CONDITIONS: 10%	
	
ANALYSIS SUMMARY:

Left Knee Chondromalacia Patella. According to the service treatment record and MEB narrative summary (NARSUM), the CI’s left knee pain began when she fell in January 2006 during basic training. She underwent diagnostic and surgical arthroscopy on 1 December 2008 consisting of a medial chondroplasty of grade 2/3 femoral condyle chondromalacia and resection of the medial plica. Despite surgery and multiple sessions of physical therapy, the CI still had significant pain with range of motion (ROM), and was taking daily nonsteroidal anti-inflammatory drugs and Vicodin  (narcotic-acetaminophen-pain  reliever)  for sleep. Examination  on  24  February  2009

revealed left knee tenderness over the medial and lateral ligaments and patellar tendon, but no edema or erythema. Patellar apprehension, laxity, and instability tests were negative. There was a positive patellar grind test (to detect patellofemoral joint disorder), and full ROM with increased pain during extension. Strength was normal. The 6 April 2009 MEB NARSUM examination, 6 months prior to separation, noted CI complaints of pain worse with standing, walking, running, jumping, pivoting, prolonged sitting, and climbing stairs. Physical examination showed no edema or erythema, but there was tenderness over the medial and lateral ligaments and patella tendon. McMurray’s testing (for meniscal tear) was negative and strength was normal. Left knee ROM was reported as “full” with increased pain during extension.

At the 14 July 2009 VA Compensation and Pension (C&P) examination, 2 months before separation, the CI reported left knee pain, rated at 3/10, and increased to 6-7/10 during twice weekly flares. He also had significant stiffness and occasional swelling. Physical examination of the left knee was within normal limits with negative McMurray’s and stability tests. After three repetitions, left knee ROM measurements showed flexion to 90 degrees (normal 140) and extension to 0 degrees (normal).

The panel directed attention to its rating recommendation based on the above evidence. The PEB rated the left knee condition 10%, analogously coded 5099-5014 (osteomalacia). The VA also rated the left knee condition 10%, but analogously coded 5299-5259 (cartilage, semilunar, removal of, symptomatic) based on the C&P examination, citing symptomatic removal of the semilunar cartilage. Members agreed there was no limitation of motion which supported a rating under the diagnostic codes for limitation of flexion or extension (5260, 5261). However, the persistence of pain after meniscal surgery warranted a 10% rating under the 5259 code (cartilage, semilunar, removal of symptomatic). There was no history or evidence of dislocated meniscus or loose body causing frequent locking with recurrent effusions (5258), 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% 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.

BOARD FINDINGS: In the matter of the 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:

2	PD-2017-04671

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Dear XXXXXXXXXX

		Reference your application submitted under the provisions of DoDI 6040.44 (Section 1554, 10 USC), PDBR Case Number PD-2017-04671.

After careful consideration of your application and treatment records, the Physical Disability Board of Review determined that the rating assigned at the time of final disposition of your disability evaluation system processing was appropriate.  Accordingly, the Board recommended no re-characterization or modification of your separation.

I have carefully reviewed the evidence of record and the recommendation of the Board.  I concur with that finding and their conclusion that re-characterization of your separation is not warranted.  Accordingly, I accept their recommendation that your application be denied.