RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXXXX	CASE:  PD-2014-03664
BRANCH OF SERVICE:  Army	SEPARATION DATE:  20040416

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was a National Guard, E4, Administrative Specialist, medically separated for “chronic bilateral knee pain,” rated at 10%.

CI CONTENTION:  Please 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 – 20040324	VARD - 20040625	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Bilateral Knee Pain	5099-5003	10%	Left Knee PFPS	5099-5014	10%	20040412	
			Right Knee PFPS	5099-5014	10%	20040412	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  20%	

ANALYSIS SUMMARY:  

Bilateral Knee.  According to service treatment records (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s bilateral knee condition began in 2002 (during advanced individual training) with running; and, was aggravated when his unit was mobilized for deployment.  He was diagnosed with bilateral patellofemoral pain syndrome (PFPS); X-rays were interpreted as “questionable slight” degenerative changes; and, there were no surgical indications.  A protracted trial of conservative treatment did not result in improvement sufficient to allow unrestricted duty and he was referred to the MEB.  The MEB forwarded “bilateral anterior knee pain” to the PEB for adjudication.

There were conflicting entries in the STR as to which knee (if either) was worse, although the NARSUM documented that the right knee was worse.  There was STR range of motion (ROM) evidence documenting flexion ranging from 120 degrees (normal 140, 45 for minimum 10%) to normal, and normal extension.  There was STR corroboration of bilateral joint stability and the absence of effusion or mechanical impingement.  There were entries documenting both the presence and absence of an antalgic gait.  There was no STR evidence contrary to any of the above ratable findings.

At the NARSUM examination on 5 March 2004 (1 month before separation), the CI reported daily knee pain, right greater than left, rendering him unable to run, march, carry heavy items or stand for extended periods.  The examiner noted some relief with the use of patellar tracking braces (not joint braces for instability).  The physical examination recorded a normal gait, tenderness, the absence of effusion, stability to stress testing in all planes, and negative signs of impingement (McMurray’s).  The ROM measurements (equal bilaterally) were flexion to 135 degrees and extension of minus 5 degrees (normal 0, minus 10 degrees for minimum 10%).  Neither the commander’s performance statement nor the profile differentiated functional limitations attributable to either knee versus the other.

At the VA Compensation and Pension (C&P) examination on 12 April 2004, 4 days before separation, the CI reported constant bilateral knee pain rated 2/10 with frequent exacerbations to 7/10 “with normal daily activity.”  The physical examination recorded “a limp favoring the right leg” (confounded by concurrent complaints of bilateral ankle and foot pain) and specified that the only positive findings were “pain McMurray [not interpreted as impingement] bilateral knees plus tenderness ....”  Normal bilateral ROM measurements were documented, specifying painful motion.

The Board directed attention to its rating recommendation(s) based on the above evidence.  The PEB’s bilateral 10% rating analogously coded 5003 (degenerative arthritis) specified application of the U. S. Army Physical Disability Agency (USAPDA) pain policy, but was compliant with VASRD §4.71a criteria under 5003 for two or more major joints.  Each of the VA’s separate 10% ratings under code 55099-5014 (analogous to osteomalacia) cited painful motion in support of the minimum compensable rating.  There was no evidence for ROM impairment, instability, locking, or frequent effusions which would achieve separate ratings higher than 10%.  The Board, IAW VASRD §4.7 (higher of two evaluations), must consider separate ratings for PEB bilateral joint adjudications; although, separate fitness assessments must justify each disability rating.  In this case, there was inadequate information to discriminate the performance limitations attributable to either knee over the other.  Since undue speculation would be required to conclude that the impairment from either knee would not itself have precluded adequate performance within the occupational specialty, members agreed that each knee was reasonably conceded as separately unfitting.  Separately compensable service ratings were thus justified, and painful motion was adequately supported by the evidence to achieve a 10% rating for both joints.  After due deliberation, and in consideration of all the evidence and mindful of VASRD §4.3 (reasonable doubt), the Board recommends separate 10% ratings for each knee under code 5024 (tenosynovitis).

BOARD FINDINGS:  In the matter of the bilateral knee pain condition, the Board unanimously recommends that each joint be rated as separately unfitting at 10%, each coded 5024 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 medical separation:

CONDITION	VASRD CODE	PERMANENT RATING	
Left Knee Pain	5024	10%	
Right Knee Pain	5024	10%	
COMBINED	20%	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20140730, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

MEMORANDUM FOR Commander

SUBJECT: Department of Defense Physical Disability Board of Review Recommendation
for XXXXXXXXXXXXXXXXXXXXX AR20160009311 (PD201403664)

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