RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXX	CASE:  PD-2014-03646
BRANCH OF SERVICE:  Army  	SEPARATION DATE:  20040527

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty, E3, Linguist Trainee, medically separated for “chronic bilateral knee pain,” with a disability rating of 0%.  

CI CONTENTION:  His condition continues to worsen and negatively impact his daily activities.  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:  

IPEB – Dated 20040315	VA* - (~3 Mos. Post-Separation)  	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Bilateral Knee Pain	5099-5003	0%	Chondromalacia Patella, L/Knee	5299-5260	10%	20040804	
			Chondromalacia Patella, R/Knee	5299-5260	10%	20040804	
Other x 0 (Not In Scope)	Other x 5	
RATING:  0%	RATING:  30%	
*Derived from VA Rating Decision (VARD) dated 20041109 (most proximate to date of separation (DOS)).  

ANALYSIS SUMMARY: 

Bilateral Knee Pain.  The CI initially developed bilateral knee pain while in basic training in early 2002 and continued with symptoms throughout her military career.  A radiographic workup revealed normal bony structures with small knee effusions bilaterally.  She underwent a prolonged period of conservative treatment without relief.  Her condition was not recommended for surgery.  She was permanently profiled in February 2004 and referred to a Medical Evaluation Board (MEB) with a diagnosis of chronic bilateral knee pain with retro-patellar pain syndrome.  At the MEB examination (26 November 2003; 6 months before separation), the CI reported a constant sharp/throbbing pain in both knees with any activity.  Her physical examination (PE) was brief and noted “minimal crepitus” to both knees.  There was no listed measurement for knee range of motion (ROM).  

At the VA Compensation and Pension (C&P) examination (28 July 2004; 2 months after separation), the CI reported bilateral knee pain, swelling, with give-way symptoms resulting in “multiple” falls.  She endorsed the inability to stand greater than 10 minutes due to knee pain.  She wore a brace over her right knee.  Her VA examination revealed bilateral knee effusions, joint-line tenderness, and decreased painful motion.  Her diagnosis was bilateral chondromalacia patella with recent right-sided surgery performed shortly after service separation.  The goniometric 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)	
PCC~8 Mo. Pre-Sep
	
MEB ~6 Mo. Pre-Sep
	
VA C&P ~2 Mo. Post-Sep
	
	Left	Right	Left	Right	Left	Right	
Flexion (140 Normal)	FROM	-	-	130	110	
Extension (0 Normal)		-	-	-5	0	
Comment	crepitus	crepitus	painful motion	
§4.71a Rating	0%-10%	0%-10%	0%-10%	10%	10%	

The Board directed attention to its rating recommendation based on the above evidence.  As previously elaborated, the PEB bundled the chronic bilateral knee pain at 0% using an analogous 5003 code (degenerative arthritis) and citing “without loss of joint motion.”  The VA separately rated the left and right knees under the analogous 5260 code (leg; limitation of flexion) at 10% each citing painful motion.  The Board first considered whether each knee condition remained separately unfitting, having decoupled them from the combined PEB adjudication.  Although both knees revealed abnormal physical findings, the service treatment record (STR) recorded evidence that the right knee possessed greater symptomatology than the left knee and therefore, the question was raised of whether the left knee was reasonably justified as separately unfitting near the time of Service separation.  

Board members carefully reviewed the chronological physical therapy (PT) treatment encounters during the 5-month pre-service separation period and agreed that CI’s condition, isolated treatment, and clinical improvements did not center about either knee independently, but rather generally to a bilateral condition.  The PT records did not indicate any minimization of symptoms when comparing each knee.  It would be highly speculative to conclude that the displayed disability confined to either single knee would be considered “not-unfitting” when compared to the other knee; however, members found it reasonable to surmise that it was the combination of pathology from both knees that rendered her unfit to perform military specialty duties.  Furthermore, the bilateral diagnosis does support the single 5003 based rating for “2 or more major joints”; thus there is VASRD §4.71a latitude for a bilateral rating in this case.  The evidence of painful motion at the VA examination also supports VASRD 4.59 criteria.  Board member’s concluded that a rating of 10%, coded 5099-5003, was a good analogy to both the pathology and disability in this case.  Therefore, after due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the Board recommended a bundled disability rating of 10% for the chronic bilateral knee condition.

BOARD FINDINGS:  In the matter of the bilateral knee condition, the Board unanimously recommends a disability rating of 10%, 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 her prior medical separation:  

CONDITION	VASRD CODE	RATING	
Bilateral Knee Pain	5099-5003	10%	
COMBINED	10%	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20130915, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

AA20160008695, XXXXXXXXXXXXXXXXXXX

Dear XXXXXXXXXXXXXXXXXXX:

The Department of Defense Physical Disability Board of Review (DoD PDBR) reviewed your application and found that your disability rating should be modified but not to the degree that would justify changing your separation for disability with severance pay to a permanent retirement with disability.  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.

Sincerely,

 

Enclosure