RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2014-02779
BRANCH OF SERVICE:  Army	BOARD DATE:  20150406
SEPARATION DATE:  20090905

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E-3 (M1 Armor Crewman) medically separated for bilateral knee pain.  The condition could not be adequately rehabilitated to meet the physical requirements of his Military Occupational Specialty, but was authorized to perform alternate physical fitness testing.  He was issued a permanent L3/S2 profile and referred for a Medical Evaluation Board (MEB).  The “bilateral knee pain” was forwarded to the Physical Evaluation Board (PEB) IAW AR 40-501.  The MEB also identified and forwarded six other conditions (adjustment disorder with anxiety and depressed mood; headaches; left hip pain; hypertension; nicotine dependence and insomnia due to stress) for PEB adjudication.  No other conditions were submitted by the MEB.  The Informal PEB adjudicated “bilateral knee pain” as unfitting, rated 20% (10% for each knee) with application of the Veterans Affairs Schedule for Rating Disabilities (VASRD).  The remaining six conditions were determined to be not unfitting.  The CI made no appeals and was medically separated.

CI CONTENTION:  “Please consider all conditions found unfitting and not unfitting by the physical evaluation board.”

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:

IPEB – Dated 20090730	VA* - Based on Service Treatment Records (STR)	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Bilateral Knee Pain (10% Right Knee + 10% Left Knee)	5099-5003	20%	Bilateral Knee Patellofemoral Syndrome	5299-5261	NSC	STR	
Adjustment Disorder…	Not Unfitting	Anxiety Disorder (Also Claimed as Adjustment Disorder…)	9413	10%	STR	
Headaches	Not Unfitting	Headaches	8100	NSC	STR	
Left Hip Pain	Not Unfitting	No VA Placement	
Hypertension	Not Unfitting	Hypertension	7101	NSC	STR	
Nicotine Dependence	Not Unfitting	No VA Placement	
Insomnia due to Stress	Not Unfitting	No VA Placement	
Other x 0	Other x 0	
RATING:  20%	RATING:  10%	
*Derived from VA Rating Decision (VARD) dated 20100203 (most proximate to date of separation [DOS]).  CI failed to report to C&P exam dated 20091217.

ANALYSIS SUMMARY:  

Bilateral Knee Pain Condition.  The CI first complained of left knee pain in October 2008, he had no problems completing basic training.  There was no injury noted and he stated his knee pain was 0/10 at rest but increased to a sharp, 6-7/10 with any activity, especially running, marching and going up stairs.  He was treated with non-steroidal anti-inflammatory medications, duty restriction, and physical therapy (PT) without a decrease in his pain.  Plain film X-rays of both knees were normal and a bone scan revealed mild increased activity in both knees.  PT accomplished goniometric range-of-motion (ROM) measurements for both knees 2 months prior to separation.  The results were:  right knee 130 degrees and left knee 135 degrees of active flexion (normal 140) with no indication of painful motion or instability.  There was no decrease in ROM after repetitive testing.

The narrative summary (NARSUM) examination prepared 2 months prior to separation noted the CI was seen by orthopedics and diagnosed with patellofemoral syndrome, bilaterally.  Magnetic resonance imaging of both knees was accomplished and both were reportedly normal (the primary documentation was not available for Board review).  The CI underwent intra-articular steroid injection in both knees that did not improve his knee pain.  The NARSUM physical exam revealed painful motion of both knees with normal leg strength, reflexes and sensation.

The Board directed attention to its rating recommendation based on the above evidence.  The PEB adjudicated the bilateral knee pain condition by applying VASRD code 5003 (degenerative arthritis) and separately rated each knee 10% citing “satisfactory evidence of painful motion” for a combined rating of 20%.  The evidence supports that the CI failed to report for a physical examination of his knees; therefore, the bilateral knee condition was determined to be “not service connected.”  The Board reviewed the evidence of any indication that would allow for the application of a knee specific VASRD code.  There was no evidence of meniscal injury or instability that would grant a higher 20% rating.  Considering the totality of the evidence and mindful of VASRD §4.3 (reasonable doubt), members agreed that a disability rating of 20% for the bilateral knee pain condition was appropriately recommended in this case.

Contended PEB Conditions.  The Board’s main charge is to assess the fairness of the PEB’s determination that the headaches; hypertension; nicotine dependence; insomnia and adjustment disorder conditions were not unfitting.  The Board’s threshold for countering fitness determinations requires a preponderance of evidence, but remains adherent to the DoDI 6040.44 “fair and equitable” standard.  After a psychiatric evaluation, the mental health conditions (adjustment disorder and insomnia) were profiled at the S2 level; the remaining contended conditions were not profiled.  None of the contended conditions were implicated in the commander’s statement and none were judged to fail retention standards.  All STR entries were reviewed and considered by the Board.  There was no performance based evidence from the record that any of these conditions significantly interfered with satisfactory duty performance.  After due deliberation in consideration of the preponderance of the evidence, the Board concluded that there was insufficient cause to recommend a change in the PEB fitness determinations for any of the contended conditions and so no additional disability ratings are recommended.

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 pain condition and IAW VASRD §4.71a, the Board unanimously recommends no change in the PEB adjudication.  In the matter of the contended headaches; hypertension; nicotine dependence; insomnia and adjustment disorder conditions, the Board unanimously recommends no change from the PEB determinations as not unfitting.  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 20140612, 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 XXXXXXXXXXXXXXXXXX, AR20150019023 (PD201402779)

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