RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2014-00403
BRANCH OF SERVICE:  Army	SEPARATION DATE:  20071104

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E-3 (Information Technology Specialist) medically separated for bilateral knee pain.  The condition could not be adequately rehabilitated to meet the physical requirements of her Military Occupational Specialty (MOS) or satisfy physical fitness standards.  She was issued a permanent L3 profile and referred for a Medical Evaluation Board (MEB).  Bilateral knee pain (slight, intermittent), no objective findings, 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 due to chondromalacia as unfitting, rated 0%, citing application of the U.S. Army Physical Disability Agency Policy (USAPDA)/Guidance Memorandum #12, dated 28 February 2005, Subject: Table of Analogous Codes.  The CI made no appeals and was medically separated.

CI CONTENTION:  “I am still having issues with my knees bothering me on a day to day basis.  I do not have a job.  I take care of my sister w/epilepsy.  This causes my knees to bother me more.”

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 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: 

IPEB – Dated 20071002 	VA* - (~4 Mos. Post-Separation)	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Bilateral Knee Pain …	5099-5003	0%	Bilateral Chondromalacia	5099-5014	NSC	20080222	
Other MEB/PEB Conditions x 0 (Not In Scope)	Other x (8)	
RATING:  0%	RATING:  0%	
*Derived from VA Rating Decision (VARD) dated 20080722 (most proximate to date of separation [DOS])

ANALYSIS SUMMARY:

Bilateral Knees.  The record shows that the CI developed bilateral, atraumatic knee pain during training in the first months after activation.  She was treated with medications, physical therapy, and duty restrictions, but her pain continued.  A bone scan on 8 December 2006 showed stress changes of the shins, ankles, and feet; the knees, however, showed no changes.  She was seen frequently over the next few months and continued to have pain despite treatment.  On examination, the range-of-motion (ROM) was full and the gait normal.  X-rays on 11 April 2007 were normal.  Magnetic resonance imagining (MRI) of the knees on 26 April 2007 showed a normal left knee and were suggestive of early degenerative changes of the cartilage of the kneecap.

The MEB narrative summary (NARSUM) was dated 27 August 2007.  The CI reported bilateral knee pain which had progressed since the previous November despite treatment and a reduction in activity.  On examination, her gait remained normal as was her posture.  The knees were stable.  Examination of the right knee was suggestive of meniscal (cartilage cushion inside the knee) irritation, but normal on the left.  The ROM was slightly reduced and painful as charted below.  On the DD Form 2808, Report of Medical Examination, on 10 September 2007, the CI reported increased knee pain with activity.  On examination, flexion was decreased, but not quantified.

The VA Compensation and Pension (C&P) examination was performed on 9 February 2008, 5 months after separation.  The CI reported that she could walk 1-1/2 miles and did not use an assistive device.  Her gait was normal, the knees were stable, and signs of meniscal irritation absent.  The ROM was full and pain free.  She had a normal knee examination and it was thought that her condition was resolved.  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)	MEB ~1 Mo. Pre-Sep	VA C&P ~5 Mo. Post-Sep	
	Left	Right	Left	Right	
Flexion (140 Normal)	132 133 133	133 133 133 	0-140	0-140	
Extension (0 Normal)	0 0 0	0 0 0	0	0	
Comment	Painful motion	Painful motion	Pain free motion	Pain free motion	
§4.71a Rating	10%	10%	0%	0%	

The Board directed its attention to its rating recommendation based on the above evidence.  The PEB rated the bilateral knee pain at 0%, coded 5099-5003 (Analogous to degenerative arthritis).  The VA determined that the bilateral knee pain was resolved and non-compensable, coded 5099-5014 (Analogous to osteomalacia).  The Board first considered if the knees were separately unfitting.  Her examination was consistently normal other than a slight decrease in ROM in both knees, an MRI which was suggestive of early cartilage degeneration of the right kneecap, and an equivocal test for meniscal irritation on the right.  The evidence does not support a determination that the left knee was separately unfitting at separation.  Severing the right knee for adjudication vice leaving the knees as a combined unfitting condition provides not advantage to the CI and is therefore not recommended.  The Board then considered the rating.  Painful motion was documented on the NARSUM examination, weeks prior to separation.  This supports a 10% rating IAW VASRD §4.59 (Painful motion).  After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (Reasonable doubt), the Board recommends a disability rating of 10% for the bilateral knee pain condition retaining the 5099-5003 codes.
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 Table of Analogous Codes for rating the bilateral knee condition was operant in this case and the condition was adjudicated independently of that policy by this Board.  In the matter of the bilateral knee condition, the Board unanimously 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:

CONDITION	VASRD CODE	RATING	
Bilateral Knee Pain…Chondromalacia	5099-5014	10%	
RATING	10%	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20140113, 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 XXXXXXXXXXXXXXXXXX, AR20160002602 (PD201400403)

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, accept the Board’s recommendation to modify the individual’s disability rating to 10% without re-characterization 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