RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXX	CASE:  PD-2013-02001
BRANCH OF SERVICE:  Army	BOARD DATE:  20150226
SEPARATION DATE:  20040312

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an activated National Guard E-6 (Heavy Vehicle Driver) medically separated for bilateral knee pain.  The bilateral knee condition could not be adequately rehabilitated to meet the physical requirements of his Military Occupational Specialty or satisfy physical fitness standards.  He was issued a permanent L3 profile and referred for a Medical Evaluation Board (MEB).  Bilateral chronic retropatellar pain syndrome (RPS) unresponsive to conservative measures was forwarded to the Physical Evaluation Board (PEB) IAW AR 40-501.  The MEB also identified and forwarded two other conditions, “myofascial lower back pain” and “painful left great toe” characterized as “neuralgia of the left great toe with a soft tissue mass overlying the 3rd and 4th web space,” for PEB adjudication.  The Informal PEB adjudicated “bilateral chronic RPS” as unfitting, rated 10%, with likely application of the Veterans Affairs Schedule for Rating Disabilities (VASRD).  The remaining conditions were determined to be not unfitting.  The CI made no appeals and was medically separated.

CI CONTENTION:  The CI elaborated no specific contention in his application.

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 when specifically requested by the CI, those conditions identified by the PEB, but determined to be not unfitting.  Any conditions outside the Board’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/Naval Records.  Furthermore, the Board’s authority is limited to assessing the fairness and accuracy of PEB rating determinations and recommending corrections, where appropriate.  The Board’s assessment of the PEB rating determinations is confined to review of medical records and all available evidence for application of the Veterans Affairs Schedule for Rating Disabilities (VASRD) standards to the unfitting medical condition at the time of separation.  The Board 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, operating under a different set of laws.  The Board gives consideration to VA evidence, particularly within 12 months of separation, but only to the extent that it reasonably reflects the severity of the disability at the time of separation.

RATING COMPARISON:

Service IPEB – Dated 20040113	VA - (4 Mos. Post-Separation) 	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Bilateral Chronic Retropatellar Pain Syndrome	
5003	
10%	Retropatellar Pain Syndrome, Left Knee	5299-5260	0%	20040721	
			Retropatellar Pain Syndrome, Right Knee	5299-5260	0%	20040721	
Other x 2  (Not in Scope)	Other x 8 	
Rating:  10%	Combined Rating:  40%	
Derived from VA Rating Decision (VARD) dated 20041214 (most proximate to date of separation [DOS]).
ANALYSIS SUMMARY:

Bilateral Knee Pain:  Treatment records evidence that the CI presented in February 2003 for radiographic evaluation of the right knee.  The X-rays demonstrated mild degenerative changes of the tibial spine and patella.  The CI was treated with physical therapy (PT), activity modification, and anti-inflammatory medications.  A PT note dated 24 June 2003 documented the onset of left knee and foot pain.  An orthopedic evaluation dated 29 August 2003 noted a history of bilateral pain since June 2003 with a diagnosis of bilateral anterior knee pain without evidence of degenerative joint disease (DJD) or meniscal tear.  Radiographic evaluation confirmed the prior diagnosis of mild degenerative changes.  An orthopedic fit for duty evaluation dated 22 February 2004 documented report of bilateral knee pain made worse with squatting and running.  The physical examination was significant for bilateral patella entrapment.  The examiner rendered a diagnosis of bilateral DJD.  The narrative summary noted a history of bilateral knee pain.  The pain was worse with prolonged sitting, stair climbing and running.  On physical examination there was tenderness to palpation with patellar grind and tenderness over the patellar tendon.  There was full active knee flexion range-of-motion (ROM) bilaterally without evidence of quadriceps atrophy.  A diagnosis of bilateral chronic RPS unresponsive to conservative measures was rendered.  At the VA Compensation and Pension examination performed 4 months after separation, the CI reported occasional slight discomfort (right greater than left) anterior knee pain with walking and some instability with climbing stairs.  The knee examination demonstrated discomfort in the para-patellar area bilaterally without instability, swelling, or locking.  A diagnosis of bilateral RPS was rendered.

The goniometric ROM evaluations in evidence which the Board weighed in arriving at its rating recommendation, along with documentation of additional ratable criteria, are summarized in the chart below.

Knee ROM
(Degrees)	MEB ~ 5 Mo. Pre-Sep	VA C&P ~4 Mo. Post-Sep	
	Left	Right	Left	Right	
Flexion (140 Normal)	145	145	“FROM”	“FROM”	
Extension (0 Normal)	0	0	“FROM”	“FROM”	
Comment	Radiographic evidence of mild degenerative joint disease			
§4.71a Rating	10%	0%	0%	

The Board directed attention to its rating recommendation based on the above evidence.  The PEB adjudicated the bilateral chronic RPS condition as unfitting with a disability rating of 10%, coded 5003.  The VA rated the bilateral RPS at 0% for each knee.  Although VASRD §4.71a permits combined ratings of two or more joints under 5003, it allows separate ratings for each compensable joint.  IAW DoDI 6040.44, if the PEB combined adjudication is not compliant with the 5003 combined rating criteria, each condition subsumed under the single disability rating must be reasonably justified as separately unfitting in order to remain eligible for rating.  In this case, a bilateral condition was profiled, determined to fail retention standards, and implicated in the commander’s statement.  Members agreed that each knee was unfitting.

The Board then considered if the evidence supported a 10% or higher disability rating for each knee.  There was no evidence of limitation of motion or painful motion (VASRD§4.59) for separate knee ratings.  There was no evidence of occasional incapacitating episodes for 20% rating under VASRD code 5003.  Considering the totality of the evidence and mindful of VASRD §4.3 (reasonable doubt), members agreed that a disability rating of 10 percent for the bilateral chronic retropatellar pain syndrome condition was appropriately recommended in this case.

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.  The Board did not surmise from the record or PEB ruling in this case that any prerogatives outside the VASRD were exercised.  In the matter of the bilateral chronic RPS condition and IAW VASRD §4.71a, the Board unanimously recommends no change in the PEB adjudication. There were no other conditions within the Board’s scope of review for consideration. 

RECOMMENDATION:  The Board, therefore, recommends that there be no re-characterization of the CI’s disability and separation determination.

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20131023, 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 XXXXXXXXXXXXXXX, AR20150011187 (PD201302001)

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 and hereby deny the individual’s application.  
This decision is final.  The individual concerned, counsel (if any), and any Members of Congress who have shown interest in this application have been notified of this decision by mail.

 BY ORDER OF THE SECRETARY OF THE ARMY:

Encl						 
CF: 
(  ) DoD PDBR
(  ) DVA