RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX  	CASE:  PD-2017-05683
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20090127

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E6, Multichannel Transmitter System Operator, medically separated for “bilateral chondromalacia of the knees” 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 -20080912	VARD - 20091014	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Bilateral Chondromalacia	5099-5003	20%	Patellar Dislocation Status Post-Surgical Repair, Left Knee	5260-8520	10%	20090609	
			Torn Lateral Meniscus Status Post Surgical Repair, Right Knee 	5260-8520	10%	20090609	
COMBINED RATING:  20%	COMBINED RATING OF ALL VA CONDITIONS:  20%	

ANALYSIS SUMMARY:  

Bilateral Chondromalacia of the Knees.  According to the service treatment record (STR) and MEB narrative summary (NARSUM), the CI underwent left knee arthroscopy in December 2005 and left patellar realignment in February 2006.  In March 2008, he underwent surgery on his right knee.  Postoperatively he improved, however he continued to experience intermittent pain and catching.  No further episodes of dislocation of either knee were noted.  X-rays revealed well-healed osteotomies bilaterally.
Left Knee.  At the 19 June 2008 MEB examination (recorded on DD Forms 2807-1 and 2808), 7 months prior to separation, the physical examination (PE) noted tenderness to the medial joint line and crepitus upon movement.  Left knee range of motion (ROM) was full but painful.  Left-sided lower extremity strength was normal.   The 12 September 2008 MEB NARSUM examination, 4 months prior to separation, noted complaints of intermittent catching, pain, and sensitivity to touch.  His PE revealed normal ROM without instability or tenderness.  There was no comment with regards to the presence or absence of painful motion.  At the 9 June 2009 VA Compensation and Pension (C&P) examination, 5 months after separation, the CI reported the ability to pedal a mountain bike but noted aching and stiffness in cold and damp weather.  His PE was detailed and completely normal.  

Right Knee.  During the MEB examination, the CI reported an inability to tolerate climbing or squatting.  The PE revealed tenderness above the right knee cap and along the medial joint line.  No edema or effusion was present.  The right knee ROM was full but painful.  Gait was normal.  At the MEB NARSUM examination, 4 months prior to separation, the CI endorsed complaints of intermittent pain and catching.  The PE was detailed but normal.  The VA C&P examination was unchanged from what was noted above.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the left and right knee conditions 10% each analogously coded 5099-5003 (degenerative arthritis), citing “limitation of motion of one major joint on each knee.”  The VA rated the left and right knee conditions 10% each, both dual coded 5260-8520 (leg, limited flexion-sciatic nerve, paralysis), based on the C&P examination, citing mild decreased sensation of the knee.  

There was no limitation of motion of either knee to support 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) for each knee. The examinations proximate to separation did not demonstrate the presence of ligamentous instability or laxity (5257), and there was no history of dislocated meniscus or loose body causing frequent locking with recurrent effusions (5258), to support a rating under those respective codes. 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).   Although VASRD code 5259 was applicable in this case for right knee meniscal repair with subsequent knee pain, it provided no higher than an alternate 10% right knee rating.  Therefore, there was no VASRD §4.71a rating higher than 10% for either knee under any applicable code, and no grounds for additional rating based on the presence of instability.  Therefore, 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.   

BOARD FINDINGS: In the matter of the bilateral knee condition 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.  

ARXXXXXXXXXXX, XXXXXXXXXXXX 

Dear XXXXXXXXXXX:

	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.

Sincerely,					      

Enclosure