RECORD OF PROCEEDINGS 
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2015-00763
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20020911

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E4, Cavalry Scout, medically separated for “chronic bilateral knee pain” with a disability rating of 0%.

CI CONTENTION:  Current knee and other conditions support a higher rating.  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 – 20020628	VARD - 20020914	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Bilateral Knee Pain	5099-5003	0%	Retropatellar Pain Syndrome, Right Knee	5099-5014	10%	20020724	
			Retropatellar Pain Syndrome, Left Knee	5099-5014	10%	20020724	
COMBINED RATING:  0%	COMBINED RATING OF ALL VA CONDITIONS:  20%	

ANALYSIS SUMMARY:  

Bilateral Knee.  The PEB combined the right and left knee conditions as a single unfitting condition coded analogously to 5003 and rated at 0% with application of the US Army Physical Disability Agency (USAPDA) pain policy.  This approach by the PEB not uncommonly reflected its judgment that the constellation of conditions was unfitting, and there was no need for separate fitness adjudications.  The panel also noted that “bundling,” the combining of two or more major joints, may be permissible under the VASRD 5003 rating requirements, and that this approach does not compromise the VASRD §4.7 directive to choose the higher of two valid ratings.  The panel’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 panel 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 referred into the DES or be found unfit because of physical disability.  When the panel recommends separate fitness recommendations in this circumstance, its recommendations may not produce a lower combined rating than that of the PEB.  The evidence for the right and left knee conditions is presented concurrently, with attendant recommendations regarding separate unfitness, and separate rating if indicated.

According to the service treatment record (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s right and left knee conditions began in 1998 with running.

Bilateral knee pain was listed on the 20 May 2002 physical profile which prohibited running and lower extremity weight lifting, but allowed a stationary bike to serve as a modified physical fitness test.

At the 25 May 2002 MEB NARSUM examination, the CI reported central, sharp and grinding knee pain that hurt when he stood up or navigated stairs; the right knee gave out going down stairs.  Physical examination revealed the CI’s ability to walk, sit, and stand well.  There was no knee swelling, tenderness, or effusion noted. The bilateral range of motion (ROM) was full, smooth, and pain-free.

The 10 June 2002 commander’s statement documented the CI’s inability to perform his military specialty due to the physical profile limitations.

At the 24 July 2002 VA Compensation and Pension (C&P) evaluation, performed 2 months before separation, the CI reported bilateral knee pain that was aggravated by bending, prolonged walking and sitting and use of stairs.  Bilateral knees were reported to buckle going down stairs and locked up occasionally.  The CI denied having knee swelling or effusion, but complained about popping and cracking.  Physical examination showed bilateral knee pain with deep knee bends with crepitus heard and palpated.  He had pain on pressure over both tibias, but his gait and stance were intact.  The active bilateral knee ROM was full.  There was no laxity, instability, swelling, effusion, redness or heat noted.

The panel considered whether the right knee condition, when considered separate from the left knee condition was unfitting for continued military service.  Both knee were profiled and implicated in the commander’s statement.  Panel members agreed that each knee could be reasonably considered separately unfitting.  The panel then considered its rating recommendation for the unfitting right and left knee conditions at the time of separation.

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the bilateral knee condition 0%, analogously coded 5099-5003 (degenerative arthritis), citing the USAPDA pain policy.  The VA rated the right knee condition 10%, analogously coded 5099-5014 (osteomalacia), based on the C&P examination 2 months before separation, citing pain on deep knee bend and crepitus heard and palpated.  The VA rated the left knee condition 10%, analogously coded 5099-5014, also citing pain on deep knee bend and crepitus heard and palpated. 

The panel agreed there was no limitation of flexion or extension in either knee 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 for either knee under those respective codes.  There was no fracture, nonunion, or malunion of the femur or tibia of either lower extremity 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 both knees as noted in the VA examination most proximate to separation supporting a 10% rating for each knee based on VASRD §4.59, §4.40 and §4.45.  After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the panel recommends a disability rating of 10% for the right knee condition, 5099-5003 and 10% for the left knee condition, 5099-5003.

BOARD FINDINGS:  In the matter of the right knee condition, the panel unanimously recommends a disability rating of 10%, coded 5099-5003 IAW VASRD §4.71a.  In the matter of the left knee condition, the panel unanimously recommends a disability rating of 10%, coded 5099-5003 IAW VASRD §4.71a.  There are no other conditions within the panel’s scope of review for consideration.  The panel 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 Right Knee Pain	5099-5003	10%	
Chronic Left 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

AR20170007018, XXXXXXXXXXXXXXXXXX

Dear XXXXXXXXXXXXXXXXXX:

	The Department of Defense Physical Disability Board of Review (DoD PDBR) reviewed your application and found that your disability rating should be modified but not to the degree that would justify changing your separation for disability with severance pay to a permanent retirement with disability.  I have reviewed the Board’s recommendation and record of proceedings (copy enclosed) and I accept its recommendation.  This will not result in any change to your separation document or the amount of severance pay.  A copy of this decision will be filed with your Physical Evaluation Board records.  I regret that the facts of the case did not provide you with the outcome you may have desired.
  
	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. 

	A copy of this decision has also been provided to the Department of Veterans Affairs.

Sincerely,