RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXXXX	CASE:  PD-2015-01046
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20040622

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

CI CONTENTION:  The CI made no specific contention.  His 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 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 - 20040412	VARD - 20010706	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Bilateral Knee Pain … 	5099-5003	0%	Right Knee Injury	5299-5257	NSC	1999 STR	
COMBINED RATING:  0%	COMBINED RATING OF ALL VA CONDITIONS:  --%	

ANALYSIS SUMMARY:  The PEB combined the right and left knee conditions under a single service disability rating, coded analogously to 5003 (degenerative arthritis) and rated 0%.  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 Board also noted that “bundling,” the combining of 2 or more major joints, may be permissible under the VASRD 5003 rating requirements, and this approach does not compromise the VASRD §4.7 directive to choose the higher of 2 valid ratings.  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 referred into the DES or be found unfit because of physical disability.  When the Board recommends separate fitness recommendations in this circumstance, its recommendations may not produce a lower combined rating than that of the PEB.  

Chronic Bilateral Knee Pain.  According to service treatment records (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s bilateral knee condition began in 2001 during basic training.  Radiographic studies, in December 2002, showed no significant findings.  An MRI in July 2003 was reported as showing early chondromalacia of the patella on the right knee and bilateral medial plica.  There was no surgical indication.  Despite treatment, the bilateral knee condition could not be adequately rehabilitated to meet the physical requirements of the CI’s military specialty and the CI was referred for an MEB.  The MEB forwarded “recurrent bilateral knee pain” for PEB adjudication.  At the time of the primary care clinic appointment on 21 October 2002, the CI reported constant knee pain with physical activity aggravating the discomfort and left knee pain was greater than the right.  On examination there was joint line tenderness with bilateral patellar grind (left greater than right) and no instability.  The MEB NARSUM, 9 February 2004, noted the CI described sharp pain in his knee, but never went to formal physical therapy or rehab.  Physical examination revealed normal appearing bilateral knee without swelling or crepitus and normal range of motion.  The VA used the CI’s STR through 1999 (4 years prior to separation) to rate his bilateral knee condition.  

The Board directed attention to its rating recommendation based on the above evidence.  The PEB rated the chronic bilateral knee pain due to chondromalacia condition 0%, coded 5299-5003 (analogous to degenerative arthritis), citing no loss of motion or joint instability.  The VA rated only the right knee as not service connected, coded 5299-5257 (analogous to knee, other impairment of: recurrent subluxation or lateral instability), citing that the STR through 1999 (4 years prior to separation) failed to show the CI suffered from a chronic right knee condition.  Board members concluded the preponderance of evidence showed neither knee condition, having been de-coupled from the combined PEB adjudication, would reasonably have caused the CI to be referred into the DES, nor would the CI have been found unfit due to either individual knee. There was no evidence of painful motion with functional loss supporting a 10% rating (based on §4.59, §4.40 and §4.45) for either knee.  There likewise was no limitation of motion which attained a minimum rating under the diagnostic codes for limitation of flexion or extension (5260, 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, the PEB indicated bilateral knee chondromalacia with abnormal diagnostic imaging which aligned with the analogous 10% criteria under VASRD code 5003 for “with X-ray evidence of involvement of 2 or more major joints or 2 or more minor joint groups.”  There were no periods of incapacitation to support the next higher 20% rating.  After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the Board recommends a disability rating of 10% for the chronic bilateral knee pain condition, coded 5099-5003.  

BOARD FINDINGS:  In the matter of the chronic bilateral knee pain condition, the Board unanimously recommends a disability rating of 10%, coded 5099-5003 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 due to Chondromalacia	5099-5003	10%	

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, 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, AR20170001101 (PD201501046)

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 10% 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