RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2014-03586
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20090531

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E4, soldier did not complete MOS training, medically separated for “right knee pain secondary to chondromalacia patella…” and “left knee pain secondary to chondromalacia patella…,” rated 10% and 10% respectively, with a combined disability rating of 20%.

CI CONTENTION:  The CI requested consideration of 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 - Dated 20090421	VARD - 20091116  	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Right Knee Pain…	5099-5003	10%	Bilateral Knee Pain Syndrome	5014	0%	STR	
Left Knee Pain…	5099-5003	10%					
Low Back Pain	Not Unfitting 	Low Back Pain	5237	NSC	STR	
COMBINED RATING:  20%	COMBINED RATING OF ALL VA CONDITIONS:  0%	

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 began shortly after enlistment and during a period of increased physical activity.  There was no direct trauma and surgery was not an option.  Despite conservative treatment, both right and left knee conditions could not be adequately rehabilitated to meet the physical requirements of her military duties and therefore, the CI was referred for an MEB.  The MEB forwarded “bilateral knee pain secondary to chondromalacia patella” for PEB adjudication.

At the MEB NARSUM examination dated 2 April 2009, 2 months prior to separation, the CI reported bilateral knee pain aggravated with prolonged standing, maneuvering stairs, or performing squats or push-ups.  Pain was relieved with sitting and resting.  Her knee-focused physical examination (PE) was detailed and near normal noting full range of motion (ROM) with evidence of painful motion.  Her diagnosis was documented as bilateral chondromalacia patella.  There was no VA Compensation and Pension (C&P) examination contained in the case file near the time of separation.  Instead documentation noted that the CI “failed to report” for a scheduled VA examination on 27 October 2009.  

The Board directed its attention to its rating recommendation based on the above evidence.  The PEB separately rated each knee condition at 10%, analogously coded 5099-5003 (degenerative arthritis), citing evidence of painful motion.  The VA rated each knee at 0% under the code 5014 (osteomalacia), citing the absence of painful or limited motion.  Board members agreed that there was no limitation of motion which supported a rating under the diagnostic codes for limitation of flexion or extension (5260, 5261).  However, evidence of painful motion with functional loss was present thus supporting a 10% rating (based on §4.59, §4.40 and §4.45).  The probative examination proximate to separation did not demonstrate the presence of ligamentous instability or laxity (5257), and there was no history of a dislocated meniscus or loose body causing frequent locking with recurrent effusions (5258), or history of surgery to remove a meniscus (5259) to support a rating under their respective codes.  Additionally, there was no fracture, non-union, or malunion of the femur or tibia to support consideration under the respective codes for knee impairment related to long bone conditions (5255, 5262).  There was no VASRD §4.71a route to a rating higher than the 10% (each knee) adjudicated by the PEB under any other closely related code.  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 condition.

Contended PEB Conditions: Low Back Pain.  The Board’s main charge is to assess the fairness of the PEB’s determination that the low back pain (LBP) condition was not unfitting.  Although the LBP was profiled and judged to fail retention standards, it was not implicated in the commander’s statement.  The condition was reviewed by the Board.  The CI’s LBP began insidiously in November 2008.  She complained of daily back pain, aggravated with overhead work, overhead arm clap, moving side to side, bending, pushups, sit-ups, crunches, and maneuvering stairs.  Her pain was alleviated with a hot shower and lying down.  Her MEB spinal focused PE was completely normal with a two degree deficit in thoracolumbar extension measured at 28 degrees (normal 30).  There was no performance based evidence from the record that the LBP condition significantly interfered with satisfactory duty performance.  After due deliberation, the Board concluded that there was insufficient cause to recommend a change in the PEB fitness determination for the contended condition and so no additional disability rating is recommended.  

BOARD FINDINGS:  In the matter of the bilateral knee condition and IAW VASRD §4.71a, the Board unanimously recommends no change in the PEB adjudication.  In the matter of the contended LBP condition, 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 20140726, 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

29 NOV 2016

SUBJECT:  Department of Defense Physical Disability Board of Review Recommendation for 
AR20160017685 (PD201403586)

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.

Enclosure

CF: 
(  ) DoD PDBR
(  ) DVA