RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXXXX	CASE:  PD-2014-01389
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20070727

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty, E6, Food Service Operations Sergeant, medically separated for “chronic bilateral knee pains due to arthritis,” with a disability rating of 10%.  

CI CONTENTION:  The applicant contends that his knees continue to worsen and negatively impact his daily activities.  He also mentions that the Veterans Administration diagnosed him with PTSD.  The CI’s complete submission is at Exhibit A.  

SCOPE OF REVIEW:  The Board’s scope of review is defined in DoDI 6040.44.  It is limited to those conditions determined by the Physical Evaluation Board (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:  

SERVICE PEB – 2007-416	VARD -20081217	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Bilateral Knee Pain…	5003	10%	Arthritis Left Knee	5260-5010	10%	20080505	
			Arthritis Right Knee	5260-5010	10%	20080505	
Other MEB/PEB Conditions x 0 (Not In Scope)	Other x 3	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  20%	

ANALYSIS SUMMARY:  

Bilateral Knee Pain.  According to the service treatment record (STR) and Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s left knee condition began in January 1995, after twisting his left knee during a running event.  The CI’s right knee condition began in March 2000 and was associated with playing basketball.  Radiographs (X-ray) done in July 2005 documented bilateral roughening of the internal surface of the patella and opposing surface of the femoral intercondylar groove with additional degenerative changes of the left knee (at the medial and lateral insertions of the collateral ligaments onto the femur, tibia and fibula).  Duty limitations were recommended for both knees (Army profile, January 2007) and included physical fitness at own pace, no airborne operations, no running, no jumping, no basketball or contact activities, and no combatives.  

At the MEB exam (DD Form 2808) dated 6 February 2007 (5 months prior to separation), the examiner noted the wear of bilateral knee braces and a normal gait.  There was bilateral patellar grind and tenderness, and bilateral lateral and medial infrapatellar tenderness.  According to the commander’s statement dated 14 February 2007, the bilateral knee pain and swelling had worsened despite reduced work hours and specific profile limitations.  According to the MEB NARSUM exam (a week later), the CI reported recurrent bilateral knee pain rated 8-9/10 with associated swelling.  The pain was aggravated by prolonged walking, bending, standing and climbing stairs.  The examiner documented the exam findings previously annotated on the DD Form 2808.  At a physical therapy visit (2 weeks later), the examiner documented a bilateral knee range of motion (ROM) of 0-120 degrees (normal 0-140), limited by pain.  

At the VA Compensation and Pension (C&P) examination in May 2008 (10 months after separation), the CI reported bilateral 9/10 knee pain that increased with standing, sitting, running, jumping climbing and descending stairs with weekly flare ups that prevented him from walking.  The examiner documented an antalgic gait, and painful motion bilaterally.  Left knee ROM was 0-128 degrees; right knee ROM was 0-138 degrees.  

The Board directed attention to the rating recommendation based on the above evidence.  The PEB assigned a 10% rating under the 5003 code (Arthritis, degenerative), citing arthritis of two major joints without independently ratable ROM.  The VA assigned a 10% rating separately to each knee using the 5260 code (Leg, limitation of flexion of) with the 5010 code (Arthritis, due to trauma) based on the VA C&P exam, citing painful or limited motion with consideration of §4.40 (Functional loss) and §4.59 (Painful motion).  The STR and the MEB NARSUM consistently documented bilateral knee pain.  There were no entries in which pain was isolated to a single knee joint.  Both knees were profiled and mentioned in the Commander’s statement, and there were no unilateral distinctions with regards to clinical features or fitness considerations.  Members agreed that the each knee independently would have rendered the CI incapable of continued service within his military specialty, were separately unfitting, and that identical coding and ratings are applicable.  

There was no evidence of either knee having a flexion limited to 30 degrees, or extension limited to 15 degrees (5260 or 5261) to support a rating higher than 10%.  There was no evidence of ligamentous instability or laxity (5257), and there was no evidence for meniscal injury causing frequent locking with recurrent effusions (5258).  VASRD §4.71a specifies that limitation of motion must be objectively confirmed by “satisfactory evidence of painful motion” and specifies a 10% rating “for each major joint or group of minor joints affected by limitation of motion” under code 5003.  There was consistent evidence of painful motion with ROM limitations supporting a 10% rating (based on §4.59).  After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt) and §4.59 (painful motion), the Board recommended that each knee be found as reasonably separately unfitting with a disability rating of 10% each; coded 5260-5010 IAW VASRD §4.71a.  

BOARD FINDINGS:  In the matter of the bilateral knee pain condition, the Board unanimously determined that each knee was separately unfitting and recommends a 10% rating for the left knee and a 10% rating for the right knee; each coded 5260-5010 and IAW VASRD §4.71a.  There were no other conditions within the Board’s scope of review for consideration.  The Board recommends that the CI’s prior determination be modified as follows, effective as of the date of the prior medical separation:  

CONDITION	VASRD CODE	PERMANENT RATING	
Left Knee Osteoarthritis 	5260-5010	10%	
Right Knee Osteoarthritis 	5260-5010	10%	
COMBINED (w/BLF)	20%	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20131022, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

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 AR20160008290 (PD201401389)

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 20%
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