RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2014-03343
BRANCH OF SERVICE:  Army	SEPARATION DATE:  20060331

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an activated National Guard E-5 (Cook) medically separated for chronic left knee pain.  The condition could not be adequately rehabilitated to meet the physical requirements of his Military Occupational Specialty.  He was issued a permanent L3 profile and referred for a Medical Evaluation Board (MEB).  The “patellofemoral syndrome w/chronic knee pain, left” was forwarded to the Physical Evaluation Board (PEB) IAW AR 40-501.  The MEB also identified and forwarded three other conditions (hypertension, plantar fasciitis, bilateral feet, ethonal abuse) for PEB adjudication.  The Informal PEB adjudicated “chronic left knee pain” as unfitting, rated 0% with likely application of US Army Physical Disability Agency (USAPDA) pain policy.  The remaining conditions were determined to be not unfitting.  The CI made no appeals and was medically separated.  

CI CONTENTION:  “Please consider all conditions.” 

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 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 20060224	VA* - (~3 Mos. Post-Separation)  	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Left Knee Pain	5099-5003	0%	Patellofemoral Syndrome, Left Knee w/Degenerative Joint Disease	5010-5260	10%	20060619	
Hypertension	Not Unfitting	Hypertension	7101	NSC	20060619	
Plantar Fasciitis, Bilateral	Not Unfitting	Plantar Fasciitis	5399-5310	0%	20060619	
Ethanol Abuse	Not Unfitting	Not Addressed	
Other MEB/PEB Conditions x 0 (Not In Scope)	Other x 3 	
RATING:  0%	RATING:  40%	
*Derived from VA Rating Decision (VARD) dated 20070321 (most proximate to date of separation (DOS)).  

ANALYSIS SUMMARY:  

Chronic Left Knee Pain Condition.  The CI presented with bilateral, left greater than right, knee pain in October 2005.  At that time he was diagnosed with degenerative arthritis and treated with activity modification and anti-inflammatory medication.  A magnetic resonance imaging study performed on 26 October 2005 evidenced left knee effusion (swelling) and tendinosis (inflammation of the patellar tendon), and degenerative changes.   An orthopedic evaluation on 16 December 2005 documented that the CI’s knee pain secondary to osteoarthritis did not resolve with activity modification, cane ambulation, and pain medication.  The narrative summary noted left knee pain which worsened with running and other impact activities.  The physical examination demonstrated full active range-of-motion (ROM), a normal gait, and no swelling.  There was no evidence of instability.  The MEB examination noted that the CI had “severe osteoarthritis of the knees with recurrent swelling” requiring recurrent arthrocentesis (syringe extraction of the fluid from the knee).  The MEB physical therapy ROM dated 13 January 2006 documented pain limited knee flexion to 100 degrees without instability.  

At the VA Compensation and Pension exam performed 3 months after separation, the CI reported bilateral knee pain with walking and running.  The pain was rated 8/10 with right greater than left swelling.  The CI reported that he used a cane, but did not have it at the examination.  The physical examination demonstrated diffuse tenderness to palpation over the patella bilaterally, active flexion to 110 degrees with pain at the end of motion, and an additional 10 degrees limitation of range of motion with repetitive movement.  Radiographic examination dated 26 June 2006 noted degenerative changes with mild to moderate joint spice narrowing.  A diagnosis of patellofemoral syndrome bilaterally with mild degenerative joint disease was rendered.  

The Board directed its attention to its rating recommendation based on the above evidence.  The PEB rated the unfitting chronic left knee pain at 0% for degenerative arthritis without significant loss of joint motion; coded 5099-5003 (analogous to degenerative arthritis).  VA rated the condition at 10% based on painful motion with x-ray evidence of degenerative changes.  The Board considered whether the evidence supported a higher than 0% rating.  The Board noted that multiple treatment notes evidenced pain with use and painful motion.  The Board also noted the radiographic evidence of degenerative changes.  The Board determined that the evidence supported a 10% rating IAW VASRD 4.40 (functional loss) and 4.59 (painful motion).  There was no evidence of leg limitation of flexion to 30 degrees, extension to 15 degrees, or recurrent moderate instability 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 the chronic left knee pain condition.  

Contended PEB Conditions The Board’s main charge is to assess the fairness of the PEB’s determination that hypertension, mild bilateral plantar fasciitis, and past history of ethanol abuse 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.  The conditions were not profiled or implicated in the commander’s statement and were not judged to fail retention standards.   All were reviewed and considered by the Board.   There was no performance based evidence from the record that any of these (or insert) 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 determination for the 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 chronic left knee pain condition, the Board unanimously recommends a disability rating of 10%, coded 5099-5003 IAW VASRD §4.71a.  In the matter of the contended hypertension, mild bilateral plantar fasciitis, and past history of ethanol abuse 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 recommends that the CI’s prior determination be modified as follows, effective as of the date of his prior medical separation:  

CONDITION	VASRD CODE	RATING	
Chronic left knee pain 	5099-5003	10%	
RATING	10%	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20140708, 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 XXXXXXXXXX, AR20160004085 (PD201403343)

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 10% 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