Chondromalacia patella is a condition involving the softening of the patellar articular cartilage.

The actual cause is unknown. Contributory causes of the condition include:

• increased stress on the patella;

• activities that cause the knee to be flexed against pressure; and

• misalignment of the patella during movement.

There is knee pain with climbing or descending stairs. The undersurface of the patella is tender to palpation.

The pain can be reproduced by having the patient extend the knee and simultaneously contract the quadriceps, while compressing the patella against the femoral condyles.

This condition is self-limiting and can be treated with exercises that strengthen the quadriceps; analgesic medications; and avoidance of activities that produce pain.

Exercises that bring the knee from a beginning fixed position into extension should be avoided.

• The rating schedule for musculoskeletal was updated on February 7, 2021. Protection still does apply and should be considered with existing evaluations (38 CFR 3.951(a)).

• Chondromalacia patella should not be recognized as a chronic disease subject to presumptive service connection under 38 CFR 3.309(a). Chondromalacia patella should be rated under the appropriate diagnostic code for a knee disability, which, in most cases, would be Diagnostic Codes 5257, 5260 or 5261.

• See VAOPGCPREC 9-2004, VAOGCPREC 09-98, and VAOPGCPREC 23-9

• You must ensure that all knee examinations record range of motion findings in both flexion and extension, in accordance with the Disability Examination Worksheets.

• Although it is permissible to assign multiple evaluations under multiple diagnostic codes for a single knee, you must always abide by the amputation rule (38 CFR 4.68).

• As always, when evaluating knee function, the provisions of 38 CFR § 4.40, 4.45, and 4.59 must be considered.

• Where knee motion is actually impeded by pain, fatigability, weakness, etc., the evaluation assigned based on limitation of motion must consider the level at which motion is limited. For example, if, on examination, a Veteran has full range of knee motion, but on repetitive motion, the knee is actually limited to 10 degrees extension and 45 degrees flexion due to fatigue, a 10% evaluation would be warranted under diagnostic code 5260 and a separate 10% evaluation would be warranted under diagnostic code 5261.

• None.