RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2015-00958
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20051222

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E6, Infantryman, medically separated for “chronic bilateral knee pain, no limitation of motion,” with a disability rating of 10%.  

CI CONTENTION:  The CI made no specific contention.  The CI’s complete submission is 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 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 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 - 20051206	VARD - 20061129	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Bilateral Knee Pain	5099-5003	10%	Patella Chondromalacia, Left Knee	5257	0%	STR	
			Patella Chondromalacia, Left Knee	5257	0%	STR	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  0%	

ANALYSIS SUMMARY:    

Chronic Bilateral Knee Pain.  According to the service treatment record (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s left knee pain began in February 1997 after a fall.  The CI’s right knee pain began in December 2003 without specific injury.  Diagnostic imaging revealed a small right-sided joint effusion and degeneration of the right knee cap.  Despite conservative treatment, to include physical therapy (PT) and local injections, both knee pain conditions could not be adequately rehabilitated to meet the physical requirements of his military duties and therefore, the CI was referred for a MEB.  The MEB forwarded “chronic bilateral knee pain” for PEB adjudication.  At a PT evaluation dated 5 November 2004, approximately 14 months prior to separation, the CI’s chief complaint was, “chronic bilateral knee pain since 1996”.  The MEB NARSUM examination on 15 November 2005, approximately 2 months prior to separation, noted complaints of chronic bilateral knee pain.  The physical examination (PE) revealed near normal, but painful range of motion (ROM); noting bilateral flexion to 135 degrees (normal = 140).  The painful motion was discovered when the CI squatted.  Kneecap tenderness and “slight” crepitus were present.  Instability tests were negative and neuro-sensory parameters were normal.  

The case file indicated that the CI “failed to report” for a VA Compensation and Pension (C&P) evaluation and therefore, this Boards’ impairment recommendation will be solely based upon MEB-driven documents as well as clinical evaluations within the STR.   

The Board directed attention to its rating recommendation based on the above evidence.  The PEB combined the right and left knee conditions under a single service disability rating, analogously coded 5003 (degenerative arthritis) and rated 10% citing pain slight and frequent.  The VA separately rated each knee at 0% under code 5257 (knee; other impairment) citing no evidence of functional impairment.  Board members carefully reviewed the chronological STR during the 2-year pre-separation period and agreed that the CI’s overall condition, isolated treatments, and generally unchanging clinical symptoms did not significantly center about either knee independently, but rather a bilateral condition.  

Board members found it reasonable to surmise that it was the combination of pathology from both knees that rendered the CI unfit to perform his military specialty.  Furthermore, the bilateral diagnosis does support the single 5003 based rating for “2 or more major joints”; thus there is VASRD §4.71a latitude for a bilateral rating in this case.  In regards to specific and alternative rating criteria, members also agreed that there was no limitation of motion which supported a rating under the diagnostic codes for limitation of flexion or extension (5260, 5261).  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).  Board member’s concluded that a rating of 10%, coded 5099-5003, was a good analogy to both the pathology and disability in this case.  After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the Board concluded that there was insufficient cause to recommend a change in the PEB’s adjudication for the chronic bilateral knee condition.

BOARD FINDINGS:  In the matter of the chronic bilateral knee pain, the Board unanimously recommends no change in the PEB adjudication.  There were no other conditions within the Board’s scope of review for consideration.  The Board, therefore, recommends that there be no re-characterization of the CI’s disability and separation determination.  

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20150607, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

SAMR-RB						

MEMORANDUM FOR Commander

08 MAR 2017

SUBJECT:  Department of Defense Physical Disability Board of Review Recommendation for 
XXXXXXXXXXXXXXXXXX, AR20170000896 (PD201500958)

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 and hereby deny the individual’s application. This decision is final. The individual concerned, counsel (if any), and any Members of Congress who have shown interest in this application have been notified of this decision by mail.

 BY ORDER OF THE SECRETARY OF THE ARMY:

Enclosure

CF: 
(  ) DoD PDBR
(  ) DVA