RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXX	CASE:  PD-2014-00451
BRANCH OF SERVICE:  Army	BOARD DATE:  20140804
SEPARATION DATE:  20050430

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an activated Reserve PFC/E-3 (15U/AIT Trainee) medically separated for a bilateral knee condition.  The knee condition could not be adequately rehabilitated to meet the physical requirements of his Military Occupational Specialty (MOS) or satisfy physical fitness standards.  He was issued a permanent U3 profile and referred for a Medical Evaluation Board (MEB).  The bilateral knee 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 pain” as unfitting, rated 10%, citing likely application of the US Army Physical Disability Agency (USAPDA) pain policy.  The CI made no appeals and was medically separated.

CI CONTENTION:  The CI writes:  “Knees are getting worse, had surgery on R Knee, May 1, 2013.  Still rehabbing, L Knee also needs work.  Very hard to go up & down stairs, stand for long periods of time, or walk long distances.  Unable to run at all, limited in family activities.”

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 condition is addressed below; and, no additional 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.

The Board acknowledges the CI’s information regarding the significant impairment with which his service-connected condition continues to burden him; but, must emphasize that the Disability Evaluation System has neither the role nor the authority to compensate members for anticipated future severity or potential complications of conditions resulting in medical separation.  That role and authority is granted by Congress to the Department of Veterans Affairs (DVA), operating under a different set of laws.  The Board considers DVA evidence proximate to separation in arriving at its recommendations; and, DoDI 6040.44 defines the 12 months interval for special consideration to post-separation evidence. Post-separation evidence is probative to the Board’s recommendations only to the extent that it reasonably reflects the disability at the time of separation.

RATING COMPARISON:

Service IPEB – Dated 20050411	VA - (5 Mos. Post-Separation)	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Bilateral Knee Pain	5099-5003	10%	Tibial Plateau Arthritis, R Knee	5010	10%	20050922	
			Tibial Plateau Arthritis, L Knee	5010	10%	20050922	
Other x 0 (Not in Scope)	Other x 0	20050922	
Combined:  10%	Combined:  20%	
Derived from VA Rating Decision (VARD) dated 20051115 (most proximate to date of separation)

ANALYSIS SUMMARY: 

Bilateral Knee Pain.  The narrative summary (NARSUM) indicated the CI had recurrent bilateral knee pain aggravated by running, marching and jumping activities.  There was no specific history of trauma and X-rays were normal.  Treatment notes from late 2004 indicated swelling, tenderness and pain limited motion.  Conservative therapy including physical therapy, injection into the knees, profile restriction and non-steroidal anti-inflammatory medication did not resolve the knee symptoms.  Diagnoses changed from (bilateral) Plica syndrome to chronic patellofemoral syndrome (severe).  X-rays images obtained on 28 November 2004 were reported as normal.  The NARSUM exam indicated bilateral knee with tenderness, full range-of-motion (ROM) and painful motion with Noble compression test.  There was no laxity or weakness noted.

The VA Compensation and Pension (C&P) exam (performed 5 months after separation), was detailed in the VASRD dated 15 November 2005.  The CI reported wearing bilateral hinged knee braces.  There was bilateral knee tenderness without laxity or weakness.  ROM on the left was 0 to 132 degrees (normal 0 to 140 degrees) with grinding and ROM decreased to 110 degrees after repetition with pain and weakness.  The right knee ROM was 0 to 120 degrees with “tenderness begins at 110 degrees”, but no decrease on repetitive motion.  X-rays images showed minimal bilateral tibial plateau arthritic changes.

The Board directs attention to its rating recommendation based on the above evidence.  The Board, IAW VASRD §4.7 (higher of two evaluations), must consider separate ratings for PEB bilateral joint adjudications; although, separate fitness assessments must justify each disability rating.  In this case, both knees were considered to fail retention standards; both were implicated by the NARSUM and both were profiled.  Members agreed therefore that each knee should be conceded as separately unfitting; and, that coding and rating features were logically identical.  The knee radiographs obtained 5 months after separation (VA) documented bilateral degenerative changes that were extremely unlikely to have not existed prior to separation.  The treatment notes documented painful motion of each knee and the NARSUM “Noble compression test” is considered painful motion.  Both plica and patellofemoral syndrome are also diagnoses characterized by pain on motion.  The CI’s contended worsening of his knees with right knee in 2013, was noted, but considered to be post-separation worsening and not indicative of the CI’s condition at the time of separation.  IAW VASRD §4.59 (painful motion) each knee warrants a 10% rating.  After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt) and §4.59 (painful motion), the Board recommends a disability rating of 10% for the left knee and a disability rating of 10% for the right knee 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.  As discussed above, PEB reliance on the USAPDA pain policy for rating the bilateral knee condition was operant in this case and the condition was adjudicated independently of that policy by the Board.  In the matter of the bilateral knee condition, the Board unanimously recommends that each joint be separately rated as follows:  an unfitting right knee condition coded 5099-5003 and rated 10%, and an unfitting left knee condition, coded 5099-5003 and rated 10%, both 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 his prior medical separation:

UNFITTING CONDITION	VASRD CODE	RATING	
Bilateral Knee Pain, Right	5009-5003	10%	
Bilateral Knee Pain, Left	5009-5003	10%	
COMBINED (w/ BLF)	20%	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20131030, 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, AR20150004346 (PD201400451)

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:

Encl						     

CF: 
(  ) DoD PDBR
(  ) DVA