RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXXXX	CASE:  PD-2014-00124
BRANCH OF SERVICE:  Army	BOARD DATE:  20150915
SEPARATION DATE:  20040603

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E-4 (Aircraft Mechanic) medically separated for bilateral knee pain.  The knee condition could not be adequately rehabilitated to meet the physical requirements of his Military Occupational Specialty (MOS).  The profile allowed for an alternate aerobic event to satisfy physical fitness standards.  He was issued a permanent L3 profile and referred for a Medical Evaluation Board (MEB).  Knee pain was forwarded to the Physical Evaluation Board (PEB) IAW AR 40-501.  No other condition was submitted by the MEB.  The Informal PEB adjudicated bilateral knee pain as unfitting, rated 10% with likely application of the Veterans Affairs Schedule for Rating Disabilities (VASRD).  The CI made no appeals and was medically separated.

CI CONTENTION:  “I do have knee problems, and back issues, there is a lot I can’t do without being in pain, I feel my rate should be more.”  His complete submission is at Exhibit A.

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 condition outside the Board’s defined scope of review (such as the additional condition cited in the contention) and any contention not requested in this application may remain eligible for future consideration by the Board for Correction of Military 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 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:  

IPEB – Dated 20040227	VA* - (~5 Mos. Post-Separation)	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Bilateral Knee Pain	5099-5003	10%	Pre-Patellar Syndrome Right Knee	5099-5019	10%	20041102	
			Pre-Patellar Syndrome Left Knee	5099-5019	10%	20041102	
Other MEB/PEB Conditions x 0 (Not In Scope)	Other x 0	
RATING:  10%	RATING:  20%	
*Derived from VA Rating Decision (VARD) dated 20041201 (most proximate to date of separation [DOS])

ANALYSIS SUMMARY:

Bilateral Knee Pain Condition.  The CI was first seen for bilateral knee pain in 2001.  His pain persisted despite medications and duty restrictions.  A bone scan on 4 June 2001 suggested stress reactions (not a fracture though) around the knees, right > left.  He was diagnosed with retro-patellar pain syndrome (RPPS) and continued duty restrictions without resolution of his pain.  Repeat X-rays on 27 May 2003 showed normal left and right knees.  Formal range-of-motion (ROM) measurements in physical therapy on 20 June 2003 lacked 5 degrees of full flexion as charted below.  Painful motion was not recorded.  At an orthopedic evaluation on 10 November 2003 for the MEB, the CI denied instability, recurrent effusions, and locking.  It was noted that his pain increased with activity level, but again, painful motion was not documented.  On examination, the reduction in motion was noted as well as a positive patellar (kneecap) grind test (consistent with RPPS).  The examination was otherwise normal without instability or signs of meniscal injury.  MRIs were recorded as normal.  The MEB narrative summary (NARSUM) was dated 15 December 2003 and recorded that the CI was compliant with all treatment.

At the VA Compensation and Pension (C&P) exam performed on 2 November 2004, 5 months after separation, the CI reported that his knee pain flared with activity, but that he did not use braces.  On examination, his posture and gait were normal.  The ROM was reduced 5 degrees in flexion and there was palpable and audible crepitus (an abnormal grinding sensation or sound) on the left.  The examination was otherwise unremarkable with stable knees without signs of meniscal injury.  There was no further limitation in motion with repetition.  The goniometric ROM evaluations in evidence which the Board weighed in arriving at its rating recommendation, with documentation of additional ratable criteria, are summarized in the chart below.

Knee ROM
(Degrees)	PT ~12 Mo. Pre-Sep	VA C&P ~5 Mo. Post-Sep	
	Left	Right	Left	Right	
Flexion (140 Normal)	135	135	135	135	
Extension (0 Normal)	0	0	0	0	
Comment	Painful motion not documented	Painful motion not documented	
§4.71a Rating	0%	0%	0%	0%	

The Board directed its attention to its rating recommendation based on the above evidence.  It carefully reviewed the records in evidence, but did not find documentation that the CI actually had painful motion in the last year on active duty.  Knee pain was clearly present though.  The PEB rated the bilateral knee pain condition at 10%, coded 5099-5003 (Analogous to degenerative arthritis).  The VA rated each knee at 10%, coded 5099-5019 (Analogous to bursitis).  The VA rater noted that although the examiner had not documented painful motion to support separate 10% ratings, the CI clearly had knee pain for “some time” and separate ratings were justified.  X-rays and MRIs were normal.  A bone scan was suggestive of stress changes, but these tend to be transient and resolve with the cessation of stress.  Also, they were obtained 3 years prior to separation reducing the value for assessing the disability at separation.  The Board considered the application of VASRD §4.59 (Painful motion), but determined that the criteria were not met.  Regardless, the PEB assigned the minimum rating of 10% for both joints using the 5003 code.  The Board did consider if the knees were separately unfitting, but the majority did not find sufficient evidence to change the PEB adjudication.  After due deliberation in consideration of the preponderance of the evidence, the Board concluded that there was insufficient cause to recommend a change in the PEB fitness determination for the bilateral knee pain condition.

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 knee pain condition and IAW VASRD §4.71a, the Board, a majority vote, 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 20131229, 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 XXXXXXXXXXXXXXXXXXXXX, AR20160000423 (PD201400124)

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:

Enclosure

CF: 
(  ) DoD PDBR
(  ) DVA