RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2015-00619
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20041110

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

CI CONTENTION:  “Review 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 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 - 20040903	VARD - 20050728	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Bilateral Knee Pain	5099-5003	0%	Patellofemoral Arthrosis, Left Knee	5010	0%	STR	
			Patellofemoral Arthrosis, Right Knee	5010	0%	STR	
COMBINED RATING:  0%	COMBINED RATING OF ALL VA CONDITIONS:  0%	

ANALYSIS SUMMARY:  

Chronic Bilateral Knee Pain.  According to service treatment records (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s chronic bilateral knee pain started with the left knee in 1994 after the CI fell down some steps and injured that knee.  The CI’s right knee began to bother him roughly 6 months after this, with no known precipitating trauma.  Radiographic evidence showed a traction osteophyte (bone spur) and lateral subluxation of the patella.  The CI underwent conservative treatment to include physical therapy, temporary profiles, and medication.  

At the orthopedic clinic examination on 24 June 2004, 5 months prior to separation, physical examination showed bilateral patellar crepitus with painful motion against resistance and with quadriceps extension, and that the CI was unable to squat without pain.  The diagnosis was patellofemoral compression syndrome bilaterally, the CI was prescribed narcotic pain medication and referred for an MEB.  There was no surgical indication, and conservative treatment did not result in improvement sufficient to allow unrestricted duty.  The MEB forwarded “bilateral patellofemoral arthrosis” for PEB adjudication.  At the MEB NARSUM examination on 4 August 2004, 3 months prior to separation, the CI reported his left and right knee buckled.  Sitting for more than one-half hour caused pain as did standing more than 15 minutes.  Activity caused knee pain while inactivity relieved symptoms.  Physical examination showed no instability bilaterally, with tenderness to palpation at the patellar tendon and along the joint line.  There was no effusion.  Range of motion (ROM) measurements recorded 115 degrees flexion (normal 140) of the right knee and 105 degrees flexion on the left.  Extension was -5 degrees (normal 0) bilaterally.  Painful motion was evident with patellofemoral compression.  There was no patellofemoral crepitus.  

The CI withdrew his request for VA rating on 12 April 2005, thus, the VA did not conduct a Compensation and Pension (C&P) evaluation in conjunction with the CI’s original VA rating decision, dated 28 July 2005, and instead based that decision on evidence from the CI’s STR.  

The Board directed attention to its rating recommendation based on the above evidence.  As noted above, the PEB bundled the right knee condition with the left knee condition and applied a single 0% rating, analogously coded 5003 (arthritis, degenerative), citing the US Army Physical Disability Agency (USAPDA) pain policy.  The VA rated the right knee and left knee conditions separately, rating each 0%, with each coded 5010 (arthritis, degenerative, due to trauma) citing a non-compensable evaluation due to the CI’s failure to report for VA examination and no evidence of painful or limited motion of a major joint.  

The Board, IAW VASRD §4.7 (higher of two evaluations), must consider separate ratings for PEB bilateral joint adjudications; although, each joint must be reasonably justified as unfitting for separate disability ratings.  In this case, both knees were considered to fail retention standards; both were implicated by the NARSUM and in the commander’s statement; both were profiled and both had a lengthy history of profiling and treatment.  Members agreed that the evidence of the record reasonably supported that each knee was separately unfitting; and, that coding and rating features were essentially identical.  

There was no limitation of flexion or extension that supported a 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), and there was no history of dislocated meniscus or loose body causing frequent locking with recurrent effusions (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 supporting a 10% rating (based on §4.59, §4.40 and §4.45) for each knee.  After due deliberation, and considering all of the evidence, the Board recommends a disability rating of 10% for the right knee condition and 10% for the left knee condition, each coded 5099-5003.  

BOARD FINDINGS:  In the matter of the bilateral chronic knee pain condition, the Board unanimously recommends that each joint be separately adjudicated as follows: an unfitting right knee condition coded 5099-5003 and rated 10%, and an unfitting left knee condition, coded 5099-5003 and rated 10%, both 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	
Chronic Bilateral Knee Pain	Right	5099-5003	10%	
	Left	5099-5003	10%	
COMBINED	20%	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20150602, 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 AR20160014886 (PD201500619)

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