RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXXXX                                                                     CASE:  PD-2014-03352
BRANCH OF SERVICE:  Army                                                                 Separation Date:  20050729

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

CI CONTENTION:  “The applicant contends his back condition and that his condition required daily medication.  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 – 20050623	VARD -  20051101 	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Bilateral Knee Pain	5099-5003	0%	Instability, Left Knee	5257	20%	20051101	
			Instability, Right Knee	5257	20%	20051101	
			DJD, Right Knee	5010-5260	10%	20051101	
			DJD, Left Knee	5010-5260	10%	20051101	
			Surgical Scars, Bilateral Knees	7805	0%	20051101	
Other MEB/PEB Conditions x 0 (Not In Scope)	Other x 12 (equals SC, NSC & deferred)	
COMBINED RATING:  0%	COMPLETE COMBINED VA RATING:  80%	

ANALYSIS SUMMARY:  

Chronic Bilateral Knee Pain.  The CI initially reported left knee pain in 1998 without any history of trauma.  The CI continued with slowly progressive left knee pain and swelling which worsened with running.  In November 2003, the CI underwent a left knee arthroscopy, lateral patellar facet chondroplasty.  A left knee X-ray in February 2004 was normal.  A bilateral knee computerized tomography scan in March 2004 was abnormal.  Despite left knee surgery, the CI continued with crepitus, pain and grinding in the anterior left knee.  He underwent a left knee arthroscopy lateral release in March 2004.  In June 2004, the CI developed right knee pain with steps, inclines, running, standing and sitting for prolonged periods of time.  He had patellar grinding on physical exam.  He underwent a right knee arthroscopy lateral release, trochlear micro fracture in June 2004.  The MEB narrative summary (NARSUM) exam,  approximately 2 months prior to separation, documented that the CI reported chronic pain and difficulty with walking distances, stairs, inclines, running and walking while carrying extra weight or bending down. The MEB NARSUM physical exam findings are summarized in the chart below.  

The VA Compensation and Pension (C&P) exam, 3 months after separation, documented that the CI reported constant achy pain and stiffness with give way.  He further reported that the left knee was worse than the right knee, although both knees were problematic.  The VA C&P physical exam findings are summarized in the chart below.  There were range of motion (ROM) evaluations in evidence, with documentation of additional ratable criteria, which the Board weighed in arriving at its rating recommendation; as summarized in the chart below.  

Knee ROM
(Degrees)	MEB ~2 Mos. Pre-Sep	VA C&P ~3 Mos. Post-Sep	
	Left	Right	Left	Right	
Flexion (140 Normal)	130	130	120	120	
Extension (0 Normal)	0	0	0	0	
Comment	Full ROM; +patellar grind; no varus/valgus instability at 0 degrees, 30 degrees
	Significant limp to left, wide-based gait; guarded; severe tenderness to palpation (TTP); swelling; severe TTP, pain with mild anterior pressure on patella; moderate swelling behind knees; moderate amount knee instability; crepitus, popping; pain limited ROM; Deluca + for loss of ROM with repetition	
§4.71a Rating	10%	10%	20% (5257)	20% (5257)	
	PEB 10%(5099-5003)			
The Board directed attention to its rating recommendation based on the above evidence.  The PEB combined the chronic bilateral knee pain condition under a single Service disability rating, coded analogously to code 5003 (arthritis, degenerative).  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 Service disability rating must be reasonably justified as separately unfitting in order to remain eligible for Service 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, both knees were profiled, considered to fail retention standards, and implicated by the NARSUM and in the commander’s statement. Members agreed that each knee was separately unfitting.
The PEB rated the chronic bilateral knee pain condition as a single Service disability at 0%, coded 5099-5003 (arthritis, degenerative).  VA rated each knee at 10% for limitation of motion; coded 5010-5260 (arthritis due to trauma- leg limitation of flexion) and at 20% for instability; coded 5257(Knee, other impairment of moderate instability).  The Board considered whether the evidence supported a higher than 0% rating.  The Board placed higher probative value on the MEB examination because it was most proximate to separation and more clearly defined the CI’s condition at the time of separation.  The Board noted that the MEB examination and multiple treatment notes most proximate to separation evidenced pain-limited knee motion for the application of VASRD§4.59 (Painful motion) and a 10% rating for each knee.  There was no evidence of the time of the MEB examination of instability or subluxation, meniscal injury, or compensable ROM that would not have resulted in a higher than 10% rating for each knee.  After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the Board recommended a disability rating of 10% for the chronic right knee pain and 10% rating for the chronic left knee pain.

BOARD FINDINGS:  In the matter of the chronic bilateral knee pain condition, the Board unanimously agreed that each knee was separately unfitting and recommends  a disability rating of 10% for each joint coded 5099-5003 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 his prior medical separation:  

CONDITION	VASRD CODE	RATING	
Chronic Right Knee Pain 	5099-5003	10%	
Chronic Left Knee Pain 	5099-5003	10%	
RATING (w/ BLF)	20%	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 2014-710 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 XXXXXXXXXXXXXXXXXXXXX AR20160007987 (PD201403352)

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