RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX		CASE:  PD-2014-03218
BRANCH OF SERVICE:  Army		SEPARATION DATE:  20070718

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E5, Health Care Specialist, medically separated for “bilateral knee pain secondary to patellofemoral pain syndrome” with a disability rating of 0%.

CI CONTENTION:  “Please consider all conditions.”  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 based upon a 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 - 20070524	VARD - 20071026	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Bilateral Knee Pain …	5099-5003	0%	Bilateral Knee Patellofemoral Pain Syndrome	5099-5014	0%	20070823	
Adjustment Disorder	Not Unfitting	Adjustment Disorder	9440	NSC	20070823	
Post Concussive Syndrome	Not Unfitting 	Traumatic Brain Injury with Post-Concussion Syndrome and Residual Migraine Headaches	8100-8045	10%	20070823	
COMBINED RATING:  0%	COMBINED RATING OF ALL VA RATINGS:  30%	

ANALYSIS SUMMARY:

Bilateral Knee Pain.  According to service treatment records (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s bilateral knee pain condition began at the end of 2004 due to unknown etiology.  He reported knee cap pain aggravated going up and down stairs and while running.  X-rays of both knees were normal and the MRI of the right knee was negative.  He was treated conservatively with physical therapy and non-steroidal anti-inflammation medicines (NSAIDs) and was issued a P3 profile.  The MEB forwarded bilateral knee pain consistent with patellofemoral pain syndrome for PEB adjudication.

The MEB NARSUM examination on 8 May 2007, 2 months prior to separation, noted complaints of worsening knee pain when carrying his gear and the presence of shooting pains into his quadriceps while doing stairs.  He reported pain and stiffness if sitting for long periods and occasional locking with severe pain, but he denied swelling.  He reported he would not squat, bend down comfortably or carry his full gear.  He was working in his primary MOS.  Physical examination showed full range of motion (ROM) bilaterally in his knees with no swelling.  Lachman’s test for instability was negative and the patellar shrug test was positive for pain in the joint.

At the 23 August 2007 VA Compensation and Pension (C&P) evaluation, performed 1 month after separation, the CI reported pain behind his kneecaps with prolonged sitting or standing with his gear or with sitting, standing or walking more than 3 hours.  There was a daily flare-up that improved with rest and NSAIDs.  Since separation it occurred on a mild basis every other day.  He denied surgery or assistive devices and noted the knee condition did not affect his work or daily routine.  Physical examination showed full ROM bilaterally with no signs of instability or subluxation.  There was no evidence of loss of motion due to pain, weakness, fatigue, incoordination or instability.

The Board directed its attention to its rating recommendation based on the above evidence.  The PEB rated the bilateral knee pain condition 0%, analogously coded 5099-5003 (degenerative arthritis), citing no loss of joint motion.  The VA also rated the bilateral patellofemoral pain syndrome condition 0%, analogously coded 5099-5014 (osteomalacia) based on the VA C&P examination 1 month after separation, citing no painful or limited motion.

The Board first considered whether separate ratings for each extremity could be supported by considering if either knee could be found reasonably justified as separately unfitting.  The Board majority concluded that both knee were clinically similar, affected by localized knee pain, and neither knee could be found reasonably justified as separately unfitting.

The Board agreed there was no STR or VA evidence of compensable limitation of motion or pain on motion.  The Board determined that the PEB’s 0% rating was supported under code 5003.  Bilateral knee X-rays and a right knee MRI showed no evidence of arthritis or other abnormality.  Absent surgical intervention, instability or abnormal boney union, alternative knee codes 5258, 5257 and 5262 were not applicable.  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 bilateral knee pain condition.

Contended PEB Conditions:  Adjustment Disorder and Post Concussive Syndrome.  The Board’s main charge is to assess the fairness of the PEB’s determination that the contended conditions were not unfitting.  The adjustment disorder is a condition not constituting a physical disability, IAW DoDI 1332.38.  Therefore, the Board has no basis for recommending it as unfitting.  The post concussive syndrome was not profiled or implicated in the commander’s statement and was not judged to fail retention standards.  There was no performance based evidence from the record that the condition 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 determination for any of these contended conditions and so no additional disability ratings are recommended.

BOARD FINDINGS:  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 adjustment disorder and post concussive syndrome conditions, the Board unanimously recommends no change from the PEB determination as not unfitting.  There were no other conditions within the Board’s scope of review for consideration.  The Board, therefore, recommends that there be no modification or 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), 

SUBJECT:  Department of Defense Physical Disability Board of Review Recommendation for 
XXXXXXXXXXXXXXXXXX, AR20160017166 (PD201403218)

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