RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXXX	CASE:  PD-2014-01724
BRANCH OF SERVICE:  Army  	SEPARATION DATE:  20080814

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was a drilling National Guard, E5, Automated Logistical Specialist, medically separated for “chronic right knee pain due to osteoarthritis” and “chronic left knee pain secondary to degenerative arthritis,” rated 10% and 10%, with a combined disability rating of 20%.  

CI CONTENTION:  The CI makes no specific contention, but indicated “right knee, left knee 10% each, and additionally lists her 30% VA ratings for each knee.”  The applicant’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 FPEB - 20080619	VARD - 20080725	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Right Knee Pain due to Osteoarthritis	5003	10%	Degenerative Arthritis, Right Knee	5003-5260	10%	20080623	
Left Knee Pain…
Degenerative Arthritis….	5003	10%	Degenerative Arthritis, Left Knee	5003-5260	10%	20080623	
COMBINED RATING:  20%	COMBINED RATING OF ALL VA CONDITIONS:  20%	

ANALYSIS SUMMARY:  

Left and Right Knee Pain.  According to service treatment records and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s right knee condition began in June 2004 while running an Army Physical Fitness Test, with no associated injury.  Surgery was performed in December 2004 to repair and contour a torn meniscus (a rubber disc that cushions the knee).  After this surgery, the CI favored her right leg, which led to left knee pain and subsequent surgery on that joint in January 2006.  The left knee underwent the same surgical treatment performed on the right knee, but additionally included smoothing of damaged cartilage to lessen friction in the left knee.  Despite treatment, the CI’s bilateral knee condition could not be adequately rehabilitated to meet the physical requirements of her military specialty, so she was referred for a MEB.  

At the MEB NARSUM exam performed on 7 March 2008 (6 months prior to separation), the CI reported frequent slight pain with flare-ups three times per month that could last as long as 3 days, which were alleviated with narcotic medication.  These flare-ups occurred with changes in the weather, after standing for more than 10 minutes, or walking more than half a mile.  Physical exam revealed no tenderness, good strength, and bilaterally equal sensation in both knees.  No instability was observed, and mild crepitus (grinding) was noted with motion.  Testing for ligament damage was negative.  

At the VA Compensation and Pension (C&P) examination on 23 June 2008 (2 months before separation), the CI reported constant daily pain rated 8/10 (on a scale of 1-10, with 10 being the worst), with occasional popping or locking sensation of the knee joints.  The symptoms were reported as worse with standing for more than ½ to 1 hour or walking more than a half mile.  The CI reported she was taking two narcotic pain tablets per day as well as over-the-counter analgesics.  She denied incapacitating episodes, and reported using knee braces for the previous 3 months (she did not wear them to the exam).  The CI reported activities of daily living were not impacted by her knee conditions.  Physical exam showed normal gait, no swelling or fluid buildup, and normal strength and stability.  “Minimal tenderness” was reported at the left knee cap.  ROM was measured as depicted in the chart above, with no associated pain on motion.  VA records documented that the CI underwent bilateral knee arthroscopic surgery on 19 February 2010 (18 months after separation), with a total left knee replacement in November 2010, and total right knee replacement in January 2013.  

The Board directed attention to its rating recommendation based on the above evidence.  The PEB rated the left and right knee conditions 10% each and used VASRD code 5003 (arthritis, degenerative) for each knee, citing degenerative arthritis for the left knee and osteoarthritis for the right knee, and loss of joint motion.  The VA rated the left and right knee conditions 10% each, coded 5003-5260 (arthritis degenerative-leg, limitation of flexion), citing painful motion.  The remote post separation surgeries and knee replacements were adjudged as post-separation worsening and not indicative of the CI’s disability picture proximate to separation.  There was no limitation of motion which attained a minimum rating under the diagnostic codes for limitation of flexion or extension (5260, 5261).  However, there was evidence of either painful motion, or functional loss, or sufficient symptomatic joint pathology supporting a 10% rating (based on §4.59, §4.40 and §4.45) as adjudicated by the PEB.  The examinations proximate to separation did not demonstrate the presence of ligamentous instability or laxity (5257), or, frequent locking with effusions or any indication of dislocated meniscus or loose body (5258) to support a rating under the respective codes.  There was no fracture, non-union, or malunion of the femur or tibia to support consideration under the respective codes for knee impairment related to long bone conditions (5255, 5262).  There is therefore no VASRD §4.71a route to a rating higher than the 10% adjudicated by the PEB under any applicable code, and no grounds for additional rating based on the presence of instability.  The Board also noted a 10% rating was supported under VASRD diagnostic code 5259 (symptomatic semilunar cartilage-meniscus) but alternative coding provided no benefit to the CI, as meniscal coding includes painful motion and dual rating was not supported 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:  In the matter of the left and right knee pain 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.  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 20140422, 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 XXXXXXXXXXXXXXXXXXXX, AR20160006819 (PD201401724)

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