RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2017-05941
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20090725

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 “right knee patellofemoral syndrome/chondromalacia” with a disability rating of 10%.   

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 - 20090512	VARD - 20090729	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Right Knee Patellofemoral Syndrome/Chondromalacia	5099-5003	10%	Right Knee Patellofemoral Syndrome	5260	10%	20090713	
Right Auditory Deficits	Not Unfitting	No VA Placement	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  10%	

ANALYSIS SUMMARY:  

Right Knee Patellofemoral Syndrome/Chondromalacia.  According to the service treatment record and MEB narrative summary (NARSUM), the CI underwent right knee surgery in April 2008 for medial plica excision and synovitis.  At a 25 September 2008 primary care clinic visit, range of motion (ROM) measurements with a goniometer documented active flexion to 110 degrees (normal 140).  There was tenderness.  On 18 November 2008, the physical therapy (PT) ROM study showed active flexion to 125 degrees limited by pain.  There was no muscle spasm, guarding, swelling, atrophy or deformity.  The examiner noted pain did not cause interference with standing, sitting or weight bearing of the right lower extremity.  
At the 24 November 2008 MEB NARSUM examination, 8 months prior to separation, the CI complained of pain exacerbated by running or climbing steps.  Physical examination showed well-healed right knee surgical scars.  The examiner noted the above-mentioned PT ROM results.

During the 13 July 2009 VA Compensation and Pension (C&P) examination, 12 days before separation, the CI reported constant daily pain without flaring that waxed and waned from moderate to severe.  Exacerbating factors included being up on it all day at work, walking about and going up and down stairs.  He also reported swelling and occasional popping and buckling.  He worked 5 days a week with a lawn care company.  Physical examination showed he wore a right knee brace and his gait favored his right leg.  He had well-healed arthroscopic surgery scars, which were non-tender, completely healed and asymptomatic.  There was no effusion, warmth or erythema noted.  There was no instability to varus or valgus testing.  ROM, after repetitive motion, was flexion to 128 degrees (with pain beginning at 90 degrees) and extension of 0 degrees (normal).

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the right knee condition 10%, coded analogously to 5003 (degenerative arthritis), citing VASRD §4.10; §4.40; §4.45 and §4.59, to include consideration of functional loss due to factors such as pain, including pain on repeated use and painful motion; fatigability; incoordination; weakness with repetitive use and flare-ups.  The VA rated the right knee condition 10%, coded 5260 (limitation of flexion), based on the C&P examination.  There was no limitation of motion which supported 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).  There was no history or evidence of dislocated meniscus or loose body causing frequent locking with recurrent effusions (5258), or history of surgery to remove a meniscus (5259) to support a rating under those 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).  There was therefore no VASRD §4.71a rating higher than the 10% adjudicated by the PEB under any applicable code. 

Contended PEB Condition:  Right Auditory Deficits.  The panel’s main charge is to assess the fairness of the PEB’s determination that the contended condition was not unfitting.  The contended condition was not profiled, implicated in the commander’s statement nor judged to fail retention standards.  There was no performance-based evidence from the record that the condition significantly interfered with satisfactory duty performance at separation.  After due deliberation, the panel concluded that there was insufficient cause to recommend a change in the PEB fitness determination for the contended condition and so no additional disability rating is recommended.  

BOARD FINDINGS:  In the matter of the right knee condition and IAW VASRD §4.71a, the panel recommends no change in the PEB adjudication.  In the matter of the contended right auditory deficits, the panel recommends no change from the PEB determination 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:

Exhibit A.  DD Form 294, dated 20170516, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Record

AR20180008265, XXXXXXXXXXXXXXXXXX

XXXXXXXXXXXXXXXXXX

Dear XXXXXXXXXXXXXXXXXX

	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