RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXX.	CASE:  PD-2013-01519
BRANCH OF SERVICE:  Army	BOARD DATE:  20141203
SEPARATION DATE:  20040716

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty SPC/E-4 (31R/Multichannel Transmission Systems Operator, Maintainer) medically separated for bilateral knee pain.  The condition could not be adequately rehabilitated to meet the physical requirements of her Military Occupational Specialty; however, her profile indicated she could take an alternate physical fitness test.  She was issued a permanent L3 profile and referred for a Medical Evaluation Board (MEB).  The bilateral knee pain condition, characterized as “chronic patellofemoral syndrome” was the only condition forwarded to the Physical Evaluation Board (PEB) IAW AR 40-501.  The Informal PEB adjudicated “bilateral knee” as unfitting, rated 0%, with likely application of the US Army Physical Disability Agency (USAPDA) pain policy. The CI made no appeals and was medically separated.

CI CONTENTION:  “They disregarded depression when I was ordered by my 1st Sergant to a psychiatrist at Ft Leavenworth.  I have also since required 2 more knee surgeries, back surgery and a blown neck.  I had a documented care wreck during my time in the Army.”  [sic]

SCOPE OF REVIEW:  The Board’s scope of review is defined in DoDI 6040.44, Enclosure 3, paragraph 5.e.(2).  It is limited to those conditions determined by the PEB to be unfitting for continued military service and those conditions identified, but not determined to be unfitting by the PEB when specifically requested by the CI.  The rating for the unfitting bilateral knee pain condition is addressed below; no additional conditions, to include the contended depression, back, and neck conditions are within the DoDI 6040.44 defined purview of the Board.  Any conditions or contention not requested in this application, or otherwise outside the Board’s defined scope of review, remain eligible for future consideration by the Board for Correction of Military Records.

RATING COMPARISON:

Service IPEB – Dated 20040604	Based on Service Treatment Records (STR)	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Bilateral Knee Pain	5099-5003	0%	Residuals, Medial Meniscus Tear	5262	10%	STR	
Other x 0 (Not in Scope)	Other x 0		
Combined:  0%	Combined:  10%	
Derived from VA Rating Decision (VARD) dated 20060518 (most proximate to date of separation)

ANALYSIS SUMMARY:

Bilateral Knee Pain Condition.  Treatment records document that the CI had a history of right knee meniscal repair surgery prior to service.  On 25 August 1998 the CI underwent a second right knee surgery for a meniscal tear with findings of abnormal patellar tracking.  Treatment records were silent for knee pain until 1 July 2002 when the CI presented with right knee pain.  She was diagnosed with retropatellar pain syndrome (patellofemoral pain syndrome).  The CI was treated with physical therapy, activity modification and anti-inflammatory medications.  The CI continued to report pain with activity and weight bearing.  On 13 May 2003 the CI underwent arthroscopic right knee debridement with evidence of degenerative joint disease (DJD) and chondromalacia (flaking of retropatellar and medial femur cartilage).  Approximately 3 months after arthroscopic surgery the CI reported bilateral retropatellar pain.  She was diagnosed with right knee quadriceps tendonitis and patellofemoral pain syndrome.  Despite 6 weeks of physical therapy the CI continued to report bilateral knee pain.  The narrative summary examination dated 11 May 2004 demonstrated right greater than left decreased knee flexion; exquisitely tender right knee (patellar and quadriceps tendons and behind the knee); positive right knee meniscal testing (McMurray) and a positive left patellar grind (evidence of retropatellar pain).  The examiner diagnosed bilateral chronic patellofemoral syndrome with recurrent patellar and quadriceps tendonitis.  At the VA Compensation and Pension examination performed 29 months after separation, the CI reported constant right knee pain and stiffness.  She reported three to four pain flare-ups per month.  The physical examination demonstrated tenderness over the right patella with pain free, full, active range-of-motion.  Radiographic results were documented as demonstrative of DJD in both knees.

The Board directed attention to its rating recommendation based on the above evidence.  The PEB adjudicated the bilateral knee pain due to patellofemoral pain syndrome as a single unfitting condition with a disability rating of 0%, analogous to DJD.  The VA described the right knee condition as “mildly disabling” residuals of a meniscus tear and assigned a 10% disability rating, code 5662 (tibia/fibula impairment of).  Although VARSD §4.71a permits combined ratings of two or more joints under 5003, as adjudicated by the PEB, it also allows individual ratings for separately compensable joints.  The Board may recommend separate ratings for joints adjudicated by the PEB as a single unfitting condition, if it is determined that each joint can be reasonably justified as separately unfitting and is compensable IAW VASRD §4.71a.

The Board considered if each knee could be reasonably justified as separately unfitting.  Both knees were profiled and implicated in the commander’s statement.  Both knees were diagnosed with retropatellar pain syndrome.  Although the right knee had more demonstrable disability then the left, both were treated with activity modification, physical therapy and pain medications.  The Board determined that each knee could be reasonably justified as separately unfitting.  The Board then considered if there was evidence for a higher than 0% rating for each knee.  The CI underwent right knee surgeries for meniscal tears.  There was arthroscopic and radiographic evidence of DJD.  The Board determined that the evidence supports a 10% disability rating for the right knee code 5259 (cartilage, semilunar, removal of, symptomatic).  The CI was diagnosed with left knee retropatellar pain syndrome and there was objective evidence of pain on physical examination for a 10% disability rating analogous code 5099-5003 (degenerative arthritis), IAW VASRD §4.59 (Painful motion) and §4.40 (functional loss).  There was no evidence of instability in either knee for additional rating under VASRD code 5257, knee other impairment of.  After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the Board recommends a 10% disability rating for each knee; a combined rating of 20%.

BOARD FINDINGS:  IAW DoDI 6040.44, provisions of DoD or Military Department regulations or guidelines relied upon by the PEB will not be considered by the Board to the extent they were inconsistent with the VASRD in effect at the time of the adjudication.  As discussed above, PEB reliance on the USAPDA pain policy DoDI 1332.39 for rating bilateral knee pain due to patellofemoral pain syndrome was operant in this case and the condition was adjudicated independently of that policy by the Board.  In the matter of the right knee pain due to patellofemoral pain syndrome, the Board unanimously determined that it was separately unfitting and recommends a disability rating of 10%, coded 5259 IAW VASRD §4.71a.  In the matter of the left knee pain due to patellofemoral pain syndrome, the Board unanimously determined that it was separately unfitting  and recommends a disability rating of 10%, coded 5099-5003 IAW VASRD §4.71a.  There were no other conditions within the Board’s scope of review for consideration.

RECOMMENDATION.  The Board recommends that the CI’s prior determination be modified as follows, effective as of the date of her prior medical separation:

UNFITTING CONDITION	VASRD CODE	RATING	
Right knee pain 	5259	10%	
Left knee pain due to patellofemoral pain syndrome	5099-5003	10%	
COMBINED	20%	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20130913, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans’ Affairs Treatment Record

SAMR-RB									

MEMORANDUM FOR Commander, US Army Physical Disability Agency 
(AHRC-DO), 2900 Crystal Drive, Suite 300, Arlington, VA  22202-3557

SUBJECT:  Department of Defense Physical Disability Board of Review Recommendation 
for XXXXXXXXXXXXXXXXX, AR20150007044 (PD201301519)

1.  I have reviewed the enclosed Department of Defense Physical Disability Board of Review (DoD PDBR) recommendation and record of proceedings pertaining to the subject individual.  Under the authority of Title 10, United States Code, section 1554a,   I accept the Board’s recommendation to modify the individual’s disability rating to 20% without recharacterization of the individual’s separation.  This decision is final.  

2.  I direct that all the Department of the Army records of the individual concerned be corrected accordingly no later than 120 days from the date of this memorandum.   

3.  I request that a copy of the corrections and any related correspondence be provided to the individual concerned, counsel (if any), any Members of Congress who have shown interest, and to the Army Review Boards Agency with a copy of this memorandum without enclosures.

 BY ORDER OF THE SECRETARY OF THE ARMY:

CF: 
(  ) DoD PDBR
(  ) DVA