RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXX	CASE:  PD-2014-00819
BRANCH OF SERVICE:  Army	BOARD DATE:  20150206
SEPARATION DATE:  20080918

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E-4 (Shower Laundry and Clothing Repair Specialist) medically separated for a bilateral knee condition.  The 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).  The bilateral knee condition, characterized as “bilateral knee pain, bilateral patellofemoral arthrosis” and “post-traumatic degenerative arthritis of the left knee” was forwarded to the Physical Evaluation Board (PEB) IAW AR 40-501.  No other conditions were submitted by the MEB.  The Informal PEB adjudicated “bilateral knee pain with left post-traumatic degenerative arthritis” as unfitting, rated 20% with likely application of the Veterans Affairs Schedule for Rating Disabilities (VASRD).  The CI made no appeals and was medically separated.

CI CONTENTION:  “Back and knee conditions are (not legible) and getting worse.”

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 20080627	VA - (2 Mos. Post-Separation)  	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Bilateral Knee Pain w/Left Post Traumatic Degenerative Arthritis	5099-5003	20%
(10% + 10%)	Left Knee, Patellofemoral Pain Syndrome	5014-5261	10%	20081114	
			Right Knee, Bone Spurs	5299-5261	0%	20081114	
Other x 0 (Not in Scope)	Other x 2 	20081114	
Combined:  20%	Combined:  20%	
Derived from VA Rating Decision (VARD) dated 20081210 (most proximate to date of separation [DOS]).

ANALYSIS SUMMARY:

Bilateral Knee Pain w/Left Post-Traumatic Degenerative Arthritis Condition.  The record indicated that the CI’s left knee pain started following a twisting injury in 2005.  Right knee pain began in 2006 without a specific traumatic event.  The CI was a runner and had bilateral knee pain with running, walking, stairs, and prolonged sitting/standing.  He was treated with non-steroidal anti-inflammatory medications and did not have any knee surgeries.  Magnetic resonance imaging report from May 2007 noted the left knee to have some degeneration of the meniscus, mild posterior cruciate ligament laxity and degenerative bone changes.  Right knee plain films documented a bone spur.

The narrative summary (NARSUM) physical exam on 22 April 2008 performed 5 months prior to separation documented an antalgic gait secondary to pain with normal knee alignment.  Both knees were stable on exam, had pain with patellofemoral compression, tenderness and no evidence of effusion.  Knee active ranges-of-motion (ROM) were limited by pain on the left from 0 degrees-20 degrees (normal 0 degrees-140 degrees) and on the right from 0 degrees-55 degrees.  The examiner stated that “in the sitting position his knee assumes at least 80 degrees of flexion.”

The PEB requested clarification of the CI’s performance and NARSUM exam ROM findings.  Repeat evaluation performed on 23 June 2008 (3 months prior to separation) documented a normal gait with the CI wearing a hinged brace on the left knee.  Repetitive ROM testing documented active ROM of 0 degrees-130 degrees (normal 0 degrees-140 degrees) for each knee with objective evidence of painful motion of the left knee.  There was mild crepitance of the left knee and no effusion present.  The PEB referenced this exam on their rating of each knee at 10% with a combined 20% rating.

At the VA Compensation and Pension exam performed 2 months after separation, the CI reported left knee pain and stiffness with no flare-ups.  He denied right knee pain or either knee giving way, locking, or instability.  He frequently used a left knee brace.  Exam documented normal lower extremity strength, reflexes and neurologic exam.  The left knee had tenderness, crepitation and “clicks or snaps” with painful ROM of 0 degrees-130 degrees.  The right knee exam was normal with painless ROM of 0 degrees-145 degrees.

The Board directed attention to its rating recommendation based on the above evidence.  The PEB specified a 10% rating for each knee with a combined 20% rating.  The treatment record consistently documented normal or near normal knee ROMs except for the NARSUM ROMs.  The repeated ROMs cited by the PEB aligned with the disability picture described in the remainder of the record and the Board adjudged that the NARSUM ROMs were not indicative of the CI’s disability picture at the time of separation.  There was no objective evidence of either knee instability on exams for possible dual rating of either knee, and no evidence of frequent effusions for any rating higher than 10% for either knee.

After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the Board concluded that there was insufficient cause to recommend a change in the PEB adjudication for the left and right knee conditions.

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 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 20140214, 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, AR20150010580 (PD201400819)

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