RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXX	CASE:  PD-2014-03335
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20011115

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty, E4, Infantryman, medically separated for “bilateral retropatellar knee pain” with a disability rating of 0%.

CI CONTENTION:  The applicant requests the Board 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 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 - 20010726	VARD - 20011126	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Bilateral Retropatellar Knee Pain	5099-5003	0%	Retropatellar Pain Syndrome, Right	5099-5024	0%	20010925	
			Retropatellar Pain Syndrome, Left	5099-5024	0%	20010925	
RATING:  0%	COMBINED RATING OF ALL VA CONDITIONS:  0%	

ANALYSIS SUMMARY:  

Bilateral Retropatellar Knee Pain.  The service treatment record indicated that the CI had direct trauma to his left knee in October 1998 and indirectly developed right knee pain while running in December of that same year.  His painful knees persisted and worsened with running and stair climbing.  X-rays of both knees were reported as normal.  Although a bone scan performed in December 1999 indicated the possibility of “stress reaction” in the upper portion of both lower legs, the knees were not involved.  Despite physical therapy, restrictions, and medication, the CI’s painful symptoms continued.  The commander’s letter noted that the CI’s bilateral knee condition “will prevent him from serving in [his] MOS in the foreseeable future due to the requirement to carry heavy loads over long distances.”  He was permanently profiled in May 2001 with a diagnosis of bilateral retropatellar pain syndrome and was referred to a Medical Evaluation Board (MEB).  

At the narrative summary (NARSUM) examination performed on 22 March 2001 (8 months prior to separation), the CI’s chief complaint was ‘”chronic bilateral knee pain.”  His physical examination (PE) revealed bilateral patellar compressive pain and tenderness.  Bilateral knee range of motion was normal.  Meniscus and instability testing did not reveal abnormalities. 

 At the VA Compensation and Pension (C&P) examination performed on 25 September 2001 (2 months prior to separation), the CI reported increased bilateral knee pain.  His comprehensive PE was normal.  His diagnosis was listed as “status post bilateral tibial stress reactions demonstrated on magnetic resonance imaging scan, resolved.”

The Board directed attention to its rating recommendation based on the above evidence.  The PEB assigned a 0% rating under an analogous 5003 code (degenerative arthritis), citing normal range-of-motion, no ligamentous laxity, and rated for pain.  The VA also assigned 0% ratings for each knee using an analogous 5024 code (tenosynovitis), citing the lacking of objective evidence of impairment.  Despite a 0% rating by both the PEB and VA, Board members first deliberated if the left and right knees, having been de-coupled from the combined PEB adjudication, remained separately unfitting and therefore subject to separate Service ratings.  Board members agreed that although the repeat radiographic evidence was noted to be resolved, the reported increase in knee pain either in one or both knees would likely have rendered the CI incapable of performing his military duties as an Infantryman.  Member consensus was that the bilateral knee condition was reasonably justified as separately unfitting and that it met VASRD §4.71a criteria for separate ratings.  In deliberation for final impairment ratings Board members considered the presence of subjective pain, but in the absence of abnormal or limiting physical parameters, members agreed that a rating of 0% was an appropriate representation of the CI’s condition near the time of service separation.  After due deliberation, considering all of the evidence the Board recommended separate unfit determinations with disability ratings of 0% for each knee.  

BOARD FINDINGS:  In the matter of the bilateral knee condition, the Board unanimously recommends that each knee be separately adjudicated as follows: an unfitting right knee condition coded 5099-5003, rated 0%, and an unfitting left knee condition, coded 5099-5003, rated 0%, both IAW VASRD §4.71a.  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 the prior to medical separation:  

CONDITION	VASRD CODE	RATING	
Right Knee Pain	5099-5003	0%	
Left Knee Pain	5099-5003	0%	
COMBINED (w/ BLF)	0%	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20140605, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record
AR20160007974, XXXXXXXXXXXXXXXXXXX

XXXXXXXXXXXXXXXXXXX

Dear XXXXXXXXXXXXXXXXXXX:

The Department of Defense Physical Disability Board of Review (DoD PDBR) reviewed your application and found that your disability description should be modified. I have reviewed the Board's recommendation and record of proceedings (copy enclosed) and I accept its recommendation.  This will not result in any change to your separation document or the amount of severance pay.  A copy of this decision will be filed with your Physical Evaluation Board records.  I regret that the facts of the case did not provide you with the outcome you may have desired.

This decision is final. Recourse within the Department of Defense or the Department of the Army is exhausted; however, you have the option to seek relief by filing suit in a court of appropriate jurisdiction.

A copy of this decision has also been provided to the Department of Veterans Affairs and to the counsel you listed on your application, XXXXXXXXXXXXXXXXXXX.

Sincerely,