RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXXXX	CASE:  PD-2014-01901
BRANCH OF SERVICE:  Army                                                          SEPARATION DATE:  20070527

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty, E3, Vehicle Mechanic, medically separated by for “bilateral knee pain,” with a disability rating of 10%.

CI CONTENTION:  The CI emphasizes his current pain and disability, and states that each knee should have rated.  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 PEB - 20070306	VARD - 20080627	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Bilateral Knee Pain	5099-5003	10%	Patellafemoral Syndrome, Left	5299-5262	10%	20080505	
			Patellafemoral Syndrome, Right	5299-5259	NSC		
RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  10%	

ANALYSIS SUMMARY:  

Bilateral Knee.  The service treatment records (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM) documented an atraumatic onset of left knee pain in March 2005 (2+ years prior to separation), followed soon by complaints of bilateral knee pain.  Although the left knee was more clinically acute, there was persistent bilateral pain which was not responsive to conservative measures.  Imaging (X-ray, bone scan, bilateral MRIs) suggested a contusion of the left knee (medial femoral condyle) and patellofemoral arthritis, and there was confirmation of intact ligaments and menisci.  These findings and the STR clinical evidence were consistent with the MEB diagnoses of retropatellar pain syndrome (RPPS) for which there were no surgical indications.  Further attempts at relief with conservative treatment were unsuccessful.  There were some outpatient STR entries noting non-specifically decreased range of motion (ROM) of one or both knees (with painful motion), although none which indicated severe ROM limitation; and, others observing grossly normal ROM.  Although there were subjective complaints of buckling and locking, there were numerous STR clinical examinations documenting the bilateral absence of effusion, joint stability to stress testing in all planes, and negative signs of impingement.  There was no STR evidence contrary to these ratable findings and no documentation of incapacitation.  

The NARSUM was conducted 16 January 2007 (4 months prior to separation) and documented “left greater than right” (subjectively “extreme”) knee pain with complaints of buckling (no subjective locking noted), which rendered the CI “unable to run, walks with a limp,” and was worsened by “squatting, kneeling, and sitting for extended periods of time.”  The NARSUM physical examination recorded bilateral findings of tenderness, the absence of effusion, stability to stress testing, and negative impingement.  The NARSUM measured ROM was bilateral flexion to 130 degrees (normal 140, 45 for minimum 10%), without note of painful motion.  The permanent L3 profile was for “bilateral [RPPS] left greater than right.”  The commander’s performance statement referenced both knees but did not differentiate separate limitations.  For unclear reasons, an addendum to the NARSUM was conducted 3 weeks later (8 February 2007) by a different provider.  This documented constant bilateral (no distinction right versus left) pain rated 5-8/10 and recorded mild bilateral anterior laxity (1+ Lachman’s, detailed as 0.5 millimeter with firm end point by earlier orthopedic consultant) with no other positive examination findings.  The measured ROM from the addendum was flexion right 105/left 90 and bilateral extension to 0 degrees (normal).  

A VA Compensation and Pension (C&P) examination was conducted 5 May 2008 (11 months after separation).  It was directed only at the left knee and documented employment as a mechanic.  Although constant pain rated 8/10 was reported, there was a 2-mile walking tolerance and the CI “denies much effect on his job activities at present.”  The VA physical examination recorded a normal gait, tenderness, the absence of effusion, stability to stress in all planes, and negative impingement.  The VA measured ROM was bilateral flexion to 140 degrees, specifying the absence of painful motion.  

The Board directed attention to its rating recommendation based on the above evidence.  The PEB bilateral knee rating at 10% analogous to 5003 (degenerative arthritis) was compliant with VASRD §4.71a criteria under 5003 for two or more major joints.  The VA’s 10% rating for the left knee analogous to 5262 (tibia and fibula, impairment of) conceded painful motion despite the C&P finding to the contrary and as above, denied service connection for the right knee.  There was no compensable ROM impairment, instability, locking, or frequent effusions which would achieve separate ratings higher than 10%.  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 Service disability rating.  In this case, especially considering an argument that the right knee was not readily justified as separately unfitting (and only equivocally compensable), members agreed that it was fair to surmise that it was the combined impairment from both joints which rendered the CI unfit and therefore a §4.71a compliant bilateral 10% rating under 5003 is appropriate.   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 of the bilateral knee condition.

BOARD FINDINGS:  In the matter of the bilateral knee condition, 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 20140501, with attachments
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, AR20160006829 (PD201401901)

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