RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2015-00147
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20040222

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

CI CONTENTION:  The applicant contends his condition continues to worsen and negatively impact his daily activities.  The applicant’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 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 - 20031118	VARD - 20040322	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Bilateral Knee Pain	5099-5003	0%	Left Knee Retropatellar Pain Syndrome	5099-5014	10%	20031223	
			Right Knee Retropatellar Pain Syndrome	5099-5014	10%	20031223	
COMBINED RATING:  0%	COMBINED RATING OF ALL VA CONDITIONS:  20%	

ANALYSIS SUMMARY:  

Bilateral Knee Pain.  According to service treatment records and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s bilateral knee conditions began in early 2001, without specific injury.  Magnetic resonance imaging (MRI) of his left knee, revealed a meniscal tear, and he underwent arthroscopic surgery in April 2003.  Post-operatively, there was improvement; however, he noticed that his other knee was also bothering him.  An MRI of his right knee showed a possible meniscal cyst, and he subsequently underwent an arthroscopy of his right knee in July 2003.  Despite treatment, the CI’s right and left knee conditions could not be adequately rehabilitated to meet the physical requirements of his military specialty and was referred for MEB.  The Board first considered if the right knee and left knee each considered alone remained separately unfitting.  In this case, both knees were considered to fail retention standards; both were implicated by the NARSUM and in the commander’s statement; and, both were profiled.  Members agreed that each knee was reasonably considered as separately unfitting; and, that coding and rating features were logically identical.  The Board then considered its rating recommendation for the unfitting left and right knee pain conditions at the time of separation.  

The range-of-motion (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)	NARSUM ~5 Mo. Pre-Sep	MEB Addendum~ 4 Mo. Pre-Sep	VA C&P ~2 Mo. Pre-Sep	
	Left	Right	Left	Right	Left	Right	
Flexion (140 Normal)	120	120	100 (100,105,100)	105 (105,110,105)	127	128	
Extension (0 Normal)	0	0	0,0,0	0,0,0	0	0	
Comment	No laxity	Pain at extremes of ROM			
§4.71a Rating	10%	10%	10%	10%	10%	10%	

At the MEB NARSUM examination, 22 September 2003, the CI reported pain in both knees with any type of kneeling, bending, squatting, and prolonged standing or running.  There was pain over the patellofemoral joint.  ROM was mildly decreased in flexion (see chart).  Bilateral examination tests for ligamentous instability and meniscus pathology were negative.  The bilateral knee pain was said to be most likely due to retropatellar pain syndrome.  A repeat knee ROM examination on 23 October 2003 with repetition is recorded in the chart and showed mild decreased flexion with pain at motion end points.  At the VA Compensation and Pension (C&P) examination performed 23 December 2003, 2 months before separation, the CI reported pain in the knees with running, prolonged sitting and climbing up and down stairs.  On examination he exhibited an abnormal gait during the examination which was observed to be improved on observation prior to and after the examination when the CI walked in and out of the clinic.  There was no crepitus, and examination tests for ligamentous instability were negative.  Results of the ROM examination with repetitive movement are in the chart and are similar to prior examinations.  The VA examiner also concluded with diagnosis of retropatellar pain syndrome.  

The Board directed attention to its rating recommendation based on the above evidence.  The PEB rated the bilateral knee condition 0% (coded 5099-5003, analogous to arthritis).  The VA rated the left and right knee conditions at 10% each, (coded 5099-5014, analogous to osteomalacia), citing limitation of motion.  However, there was no limitation of flexion or extension that supported a minimum rating under the VASRD diagnostic codes for limitation of motion (5260 or 5261).  The examinations proximate to separation did not demonstrate the presence of ligamentous instability or laxity (5257), frequent locking with effusions or any indication of dislocated meniscus or loose body (5258), or history of surgery to remove a meniscus (5259) to support a rating under the respective codes.  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).  However, there was evidence of painful motion with functional loss in each knee, supporting a 10% rating for each (based on §4.59, §4.40 and §4.45).  The Board also noted a 10% rating was supported under VASRD diagnostic code 5259 (Cartilage, semilunar, removal of, symptomatic) but provided no benefit to the CI, as meniscal coding includes painful motion.  After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the Board recommends a disability rating of 10% for the left knee, coded 5099-5003, and 10% for the right knee, coded 5099-5003, for a combined rating of 20%.  

BOARD FINDINGS:  In the matter of the bilateral knee condition, the Board unanimously recommends a disability rating of 10% for each knee, coded 5099-5003, for a combined rating of 20% 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	
Left Knee Retropatellar Pain Syndrome	5099-5003	10%	
Right Knee Retropatellar Pain Syndrome	5099-5003	10%	
RATING (w/ BLF)	20%	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20150205, 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 XXXXXXXXXXXXXXXXXX AR20160014225 (PD201500147)

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