[AR Number], XXXXXXXXXX

XXXXXXXXXX
XXXXXXXXXX
XXXXXXXXXX

Dear XXXXXXXXXX:

The Department of Defense Physical Disability Board of Review (DoD PDBR) reviewed your application and found that your disability rating should be modified but not to the degree that would justify changing your separation for disability with severance pay to a permanent retirement with disability.  I have reviewed the Board’s recommendation and record of proceedings (copy enclosed) and I accept its recommendation.  This will not result in any change to your separation document or the amount of severance pay.  A copy of this decision will be filed with your Physical Evaluation Board records.  I regret that the facts of the case did not provide you with the outcome you may have desired.
  
	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. 

	A copy of this decision has also been provided to the Department of Veterans Affairs.

Enclosure

RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXX	CASE:  PD-2017-04834
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20050901

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E4, Military Police, medically separated “chronic right knee pain” with a disability rating of 0%. 

CI CONTENTION:  Review original disability rating.  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 - 20050810	VARD - 20060426	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Right Knee Pain	5099-5003	0%	Chondromalacia Patella, Right Knee	5257	10%	STR	
COMBINED RATING:  0%	COMBINED RATING OF ALL VA CONDITIONS:  10%	

ANALYSIS SUMMARY:  

Chronic Right Knee Pain.  According to the service treatment record (STR) and MEB narrative summary (NARSUM), the CI underwent right knee surgery for chondromalacia patella in October 2004.  Despite surgery, she continued to have right knee pain.  At the 4 April 2005 orthopedic clinic visit, review of the arthroscopic pictures of the right knee led to diagnoses of chondromalacia patella and chondromalacia of the medial femoral condyle.  

The 12 May 2005 MEB NARSUM examination, 4 months prior to separation, noted complaints of difficulty climbing stairs and painful grinding and popping of the patella.  Physical examination showed tenderness of the medial joint line (MJL) and patella, with bruising along the MJL.  Gait was normal and the right knee was stable, but provocative testing for meniscal pathology caused pain (equivalent to painful motion).  There was crepitus with knee flexion and extension and range of motion (ROM) testing showed 120 degrees of flexion (normal 140) and 0 degrees of extension (normal).  Painful motion was not addressed.  There was no VA examination proximate to separation in evidence.

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the right knee condition 0%, analogously coded 5099-5003 (degenerative arthritis), citing degenerative arthritis without significant loss of joint motion.  The VA rated the right knee condition 10%, coded 5257 (knee impairment due to recurrent subluxation or lateral instability), based on the STR, citing “chondromalacia patella of the right knee status post arthroscopy in accordance with VA scheduler rating criteria.”

There was no limitation of flexion or extension that supported a rating under the VASRD diagnostic codes for limitation of motion (5260 or 5261).  However, IAW VASRD 5003 rating rules, a 10% rating is applicable for a major joint with imaging evidence of arthritis affected by limitation of motion which was objectively confirmed by crepitus with flexion and pain with meniscal testing.  The panel considered other VASRD knee codes, but all were less applicable and/or not advantageous for rating.  After due deliberation, considering all the evidence and mindful of VASRD §4.3 (reasonable doubt), the panel recommends a disability rating of 10% for the right knee condition, coded 5003.  

BOARD FINDINGS:  In the matter of the right knee condition, the panel recommends a disability rating of 10%, coded 5003 IAW VASRD §4.71a.  There are no other conditions within the panel’s scope of review for consideration.  

The panel recommends the CI’s prior determination be modified as follows, effective the date of medical separation:  

CONDITION	VASRD CODE	PERMANENT RATING	
Chronic Right Knee Pain	5003	10%	

The following documentary evidence was considered: