RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXXX	CASE:  PD-2014-03237
BRANCH OF SERVICE:  Army  	SEPARATION DATE:  20060515

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was a Reserve E-6 (Food Service Specialist) medically separated for “bilateral knee pain with arthritis,” rated at 0%.  

CI CONTENTION:  The applicant requests consideration of all conditions.  Her 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 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 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 20060327	VA* - (~10 Mos. Post-Separation)  	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Bilateral Knee Pain	5003	0%	Left Knee Injury w/Chrondromalacia and Mild Degenerative Changes	5257-5010	10%	20070314	
			Right Knee DJD	5260-5010	10%		
Other x 0 (Not In Scope)	Other x 12	
RATING:  0%	RATING:  40%	
*Derived from VA Rating Decision (VARD) dated 20070720 (most proximate to date of separation (DOS).

ANALYSIS SUMMARY:  

Bilateral Knee Pain Condition.  Treatment records evidence that the CI had a 15-year history of bilateral knee pain secondary to degenerative joint disease (DJD) prior to her acute episode of increased bilateral knee pain in November 2004.  The CI was treated with anti-inflammatory medication, physical therapy, and activity modification.  At narrative summary (NARSUM) examination dated 20 December 2005 the CI reported constant, bilateral knee pain rated 2-3/10.  She used anti-inflammatory medications and occasional muscle relaxant for pain relief.  The physical examination demonstrated a normal gait, positive patellar grind, and peripatellar, medial, and lateral joint line tenderness to palpation.  The examiner documented radiographic evidence of mild to moderate bilateral knee DJD.  At the VA Compensation and Pension (C&P) examination performed 10 months after separation, the CI reported 7/10 daily,  aching, bilateral knee pain.  She reported intermittent use of cane for ambulation.  The physical examination demonstrated painful right knee motion, bilateral knee crepitus, and normal ambulation and gait.  The examiner noted that there was no observed use any assistive devices for ambulation or support.  A diagnosis of bilateral knee DJD was rendered.  The goniometric range-of-motion (ROM) evaluations in evidence which the Board weighed in arriving at its rating recommendation, with documentation of additional ratable criteria, are summarized in the chart below.

Knee ROM
(Degrees)	MEB ~5 Mo. Pre-Sep
(20051220) 	VA C&P ~10 Mo. Post-Sep
(20070314) 	
	Left	Right	Left	Right	
Flexion (140 Normal)	130	130	121	116	
Extension (0 Normal)	0	0	0	0	
Comment	Painful motion	Painful motion	Pain with use	Painful motion	
§4.71a Rating	10%	10%	10%	10%	

The Board directed its attention to its rating recommendation based on the above evidence.  The PEB rated the unfitting bilateral knee DJD as a single unfitting condition at O%; coded 5003 (degenerative arthritis).  The VA rated the condition at 10% for each knee, coded 5257-5010 (knee impairment other-arthritis due to trauma).  Although VASRD §4.71a permits combined ratings of two or more joints under 5003, it allows separate ratings for separately compensable joints.  IAW DoDI 6040.44 if the PEB combined adjudication is not compliant with the 5003 combined rating criteria, each condition subsumed under the single disability rating must be reasonably justified as separately unfitting in order to remain eligible for rating.  The Board’s initial charge in this case was directed at determining if the PEB’s combined adjudication was justified in lieu of separate ratings.  In this case a bilateral condition was profiled, determined to fail retention standards, and implicated in the commander’s statement.  Members agree that each knee was separately unfitting.  The Board then considered whether the evidence supported a higher than 0% rating.  Multiple treatment notes and the NARSUM and VA examinations documented subjective reports of pain with use and objective findings of bilateral crepitus and painful motion.  Board members agreed that the evidence supports a 10% rating IAW VASRD §4.40 (functional loss) and §4.59 (painful motion).  There was no evidence of incapacitating pain episodes, moderate knee impairment, or leg limitation of motion to 30 degrees of flexion and 15 degrees of extension for a higher rating.  After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the Board recommends a disability rating of 10% for each knee for the bilateral knee DJD condition.  

BOARD FINDINGS: In the matter of the bilateral knee degenerative joint disease condition, the Board unanimously determined that each knee was unfitting and recommends a disability rating of 10% for each knee, coded 5003 for a combined rating of 20%  IAW VASRD §4.71a, §4.40, and §4.59.  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 her prior medical separation:  

CONDITION	VASRD CODE	RATING	
Right Knee Pain 	5003	10%	
Left Knee Pain	5003	10%	
RATING (w/ BLF)	20%	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20140703, 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 XXXXXXXXXXXXXXXXXXXX, AR20160004410 (PD201403237)

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