RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXXXX	CASE:  PD-2014-04195
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20060224

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E4, Technical Supply Clerk, medically separated for “chronic bilateral knee pain,” with a disability rating of 10%.

CI CONTENTION:  The CI contends her condition continues to worsen.  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 - 2060130	VARD – 20060907	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Bilateral Knee Pain	5099-5003	10%	Patellofemoral Pain Syndrome Bilateral Knees	5299-5024	0%	STR*	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  0%	
*Applicant unable to attend exam due to pregnancy.  VARD 20070521 increased rating to 10%.

ANALYSIS SUMMARY:  

Chronic Bilateral Knee Pain Condition.  The record shows that the CI had the onset of bilateral knee pain shortly after beginning basic training.  A bone scan on 3 December 2003 showed bilateral stress changes of the knees and shin bones (tibiae).  She was treated with medications, physical therapy, and duty modification, but her pain persisted.  X-rays on 30 January 2004 were normal.  In orthopedics on 4 February 2004 she was noted to have bilateral patello-femoral syndrome (PFS).  X-rays of the lower legs were normal.  In a follow-up in orthopedics on 9 March 2004, she was noted to have full range of motion (ROM) and stable knees.  Signs of meniscal irritation were not recorded.  The left knee was noted to have crepitus (an audible or sensible grating sensation).  MRIs of both knees on 22 October 2005 were normal.  At the narrative summary (NARSUM) dated 2 November 2005, the CI reported that her knees swelled and went numb with locking.  On examination, she was noted to have normal ROM, but bilateral tenderness.  Painful motion was not recorded.  The CI did not attend the scheduled VA Compensation and Pension (C&P) examination.  

The Board directed its attention to its rating recommendation based on the above evidence.  The PEB rated the bilateral knee pain condition at 10%, coded 5099-5003 (analogous to degenerative arthritis).  The VA assigned a 0% rating, coded 5299-5024 (tenosynovitis), since the CI did not show for her examination.  It was subsequently raised to 10%, retroactive to separation, based on a post-separation examination dated 4 January 2007.  The Board noted that the PEB rated the bilateral knee condition as a single condition.  The Board observed that even if each knee was determined to be separately unfitting, the ROM was normal as was the MRI.  The evidence does not support separate compensable ratings for each knee.  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 PFS condition.  

BOARD FINDINGS:  In the matter of the chronic bilateral knee pain condition and IAW VASRD §4.71a, the Board unanimously recommends no change in the PEB adjudication.  There were no other conditions within the Board’s scope of review for consideration.  The Board, therefore, recommends that there be no re-characterization of the CI’s disability and separation determination.  

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20141028, 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 AR20160013826 (PD201404195)

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.

 BY ORDER OF THE SECRETARY OF THE ARMY:

Enclosure

CF: 
(  ) DoD PDBR
(  ) DVA