RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2015-00569
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20090306

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E3, Basic Trainee, medically separated for “bilateral knee pain secondary to residual healing tibial stress fractures” (10% right knee and 10% left knee), with a disability rating of 20%.  

CI CONTENTION:  “Still have difficulty with prolonged bent or straight knee w/pain.  Big toes on both feet are often numb after walking or being on feet for extended periods.  Continued occasional swelling.”  The complete submission is at Exhibit A.  

SCOPE OF REVIEW:  The panel’s scope of review is defined in DoDI 6040.44.  It is limited to review of disability ratings assigned 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 or non-compensable.  Any conditions outside the panel’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 panel’s authority is limited to assessing the fairness and accuracy of PEB rating determinations and recommending corrections, where appropriate.  The panel’s assessment of the PEB rating determination is based on 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(s) at the time of separation.  The panel 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 panel 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 - 20090211	VARD - 20090525	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Bilateral Knee Pain…	5299-5262	20% = Right 10% /Left 10%	Residuals, Tibial Stress Fractures with Pain, Bilateral Knee Disorders	5262	Not Service Connected (NSC)	20090413	
COMBINED RATING: 20%	COMBINED RATING OF ALL VA CONDITIONS:  0%	

ANALYSIS SUMMARY:  

Bilateral Knee Pain….  According to the service treatment record and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s bilateral knee pain condition began in October 2008 during basic training.  Radiographic studies (X-rays and bone scan) in October 2008 showed stress fractures in both medial tibial plateaus (MTPs), with radiographic healing documented in January 2009.  

At the 7 January 2009 MEB NARSUM examination, 2 months prior to separation, the CI reported constant pain with flares after prolonged standing, and the inability to run, march, or complete basic training.  The physical examination showed tenderness at the bilateral MTPs and pain with flexion on the right.  Right knee range of motion (ROM) was from 0-140 degrees (normal); left knee ROM was 0-135 degrees.  There was no evidence of ligamentous laxity or injury, and no weakness, incoordination or lack of endurance on repetition. 

At the 13 April 2009 VA Compensation and Pension (C&P) evaluation, 1 month after separation, the CI reported numbness, pain, and weakness in the bilateral knees.  The physical examination showed a bilateral ROM of 0-140 degrees and no locking, crepitus, instability, or guarding.  There was no evidence of painful motion, fatigue, weakness, lack of endurance, or incoordination after repetition.  Radiographic evaluations (X-rays) showed no evidence of fracture or other significant bone, joint, or soft tissue abnormality.  

The panel directed attention to the rating recommendation based on the above evidence.  The PEB rated 20% for the bilateral knee condition granting 10% for the right knee and 10% for the left knee, analogously coded 5299 - 5262 (tibia and fibula, impairment of), citing painful ROM of 2 major joints; and IAW VASRD §4.40 (functional loss), §4.45 (the joints) and §4.59 (painful motion).  The VA did not grant service connection for the “residuals, tibial stress fractures with pain, bilateral knee” condition, coded 5262, based on the C&P examination approximately 1 month after separation, citing no evidence of chronic disability in either knee.  

The panel considered the evidence for rating.  There was no evidence of ‘moderate’ knee or ‘marked’ knee disability to support a higher rating for either knee under the 5255 (femur, impairment of) and 5262 codes (tibia and fibula, impairment of).  There was no limitation of motion (5260, 5261), and no history of dislocated meniscus or loose body causing frequent locking with recurrent effusions (5258) to support a higher rating for either knee under those respective codes.  Finally, there was no evidence of ligamentous instability or laxity of either knee that would warrant a higher rating under the 5257 code.  

After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the panel concluded that there was insufficient cause to recommend a change in the PEB adjudication for the bilateral knee condition.  

BOARD FINDINGS:  In the matter of the bilateral knee condition and IAW VASRD §4.71a, the panel unanimously recommends no change in the PEB adjudication.  There are no other conditions within the panel’s scope of review for consideration.  The panel, 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 20150603, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

AR20170007006, XXXXXXXXXXXXXXXXXX 

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Dear XXXXXXXXXXXXXXXXXX:

	The Department of Defense Physical Disability Board of Review (DoD PDBR) reviewed your application and found your separation disability rating and your separation from the Army for disability with severance pay to be accurate.  I have reviewed the Board’s recommendation and record of proceedings (copy enclosed), and I accept its recommendation.  I regret to inform you that your application to the DoD PDBR is denied.  

	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.

Sincerely,					       
						      					
Enclosure