RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXXXX	CASE:  PD-2015-00631
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20060726

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty, E3, Information Technology Specialist, medically separated for “bilateral atraumatic knee pain,” with a disability rating of 0%.

CI CONTENTION:  “Losing weight would have stopped the issue.  Injury occurred during basic.”  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 – 20060531	VARD – No VA Claim	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Bilateral Atraumatic Knee Pain	5099-5003	0%	The CI did not submit a VA claim	
COMBINED RATING:  0%	COMBINED RATING OF ALL VA CONDITIONS:  0%	

ANALYSIS SUMMARY:  

Bilateral Knee Pain.  According to service treatment record (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM) the CI’s left knee pain began in late 2004 after falling while running and right knee pain insidiously began in early 2005.  Diagnostic imaging (X-ray) of both knees were normal.  There was no surgical indication, and conservative treatment of medications, restrictions, and physical therapy (PT) did not result in improvement sufficient to allow unrestricted duty and she was referred to a MEB.  The MEB forwarded “bilateral knee patellofemoral syndrome, left greater than right,” for PEB adjudication.

At the MEB NARSUM on 17 April 2006 (3 months prior to separation), the CI reported bilateral knee pain (left > right), rated 3/10 pain scale at best and 8-9/10 pain scale with prolonged standing, walking, bending, squatting, lifting, carry weight, climbing stairs, and impact activities.  She maintained the ability to perform activities of daily living.  Her MEB physical examination (PE) revealed bilateral knee tenderness (left > right) and left-sided mild retro-patellar (kneecap) grind.  Examination tests for ligamentous instability and or meniscus pathology were negative.  Bilateral knee range of motion (ROM) was painful and decreased at 125 degrees of flexion (normal = 140).  Extension of both knees was normal at 0 degrees.  The CI did not submit a VA claim, therefore, there is no VA Compensation and Pension (C&P) examination nor a VA rating decision determination. 

The Board directed attention to its rating recommendation based on the above evidence.  The PEB combined the left and right knee conditions as a single unfitting condition analogously coded 5099-5003 (degenerative arthritis) and rated 0% with application of the USAPDA pain policy.  The Board’s initial charge in this case was therefore directed at determining if the PEB’s approach of combining conditions under a single rating was justified in lieu of separate ratings.  When considering a separate rating for each condition, the Board considers each bundled condition to be reasonably justified as separately unfitting unless a preponderance of evidence indicates the condition would not cause the member to be found unfit because of physical disability.  Board members carefully considered the persistent symptoms of both knees and although the left knee appeared more objectively impaired than the right, member majority concluded that the painful motion present in either knee coupled with functional loss and a subjective pain level of 8-9/10 with simple motion maneuvers, would support the reasonable justification that either knee condition separately contributed to the CI’s inability to perform her military duties and accordingly a separate disability rating is recommended.

The probative MEB examination proximate to separation did not demonstrate the presence of ligamentous instability or laxity (5257), and there was no history of a 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 their respective codes.  Additionally, 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).  After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the Board majority recommends a separately unfit determination with a disability rating of 10% for the right knee pain condition and 10% for the left knee condition.  

BOARD FINDINGS:  In the matter of the bilateral knee pain condition, the Board majority recommends separate disability ratings of 10% for each knee analogously coded as 5099-5003 IAW VASRD §4.71a.  The single voter for dissent recommended no change and did not elect to submit a minority opinion.  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	5099-5003	10%	
Right Knee Pain	5099-5003	10%	
COMBINED	20%	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20150601, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

SAMR-RB										

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, AR20170000308 (PD201500631)

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