RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXXXX	CASE:  PD-2015-01196
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20060118

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E5, Cryptologic Linguist, medically separated for “bilateral knee pain” rated 0%.

CI CONTENTION:  The CI made no specific contention.  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 - 20051013	VARD - 20060609	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Bilateral Knee Pain	5099-5003	0%	Bilateral Retro Patellar Pain Syndrome	5099-5010	0%	STR	
COMBINED RATING:  0%	COMBINED RATING OF ALL VA CONDITIONS:  0%	

ANALYSIS SUMMARY:  

Bilateral Knee Pain.  The PEB combined the bilateral knees under a single disability rating, coded analogously to 5003 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 panel 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 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.  

According to the service treatment record (STR) and Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s bilateral knee pain condition began in January 2001 with an insidious onset.  On 28 April 2005, radiography of the bilateral knees showed no evidence of fracture, dislocation or other abnormality and there was no joint effusion or significant arthritic change.  The joint space was adequately maintained.  The examiner opined normal knees.

During the 4 August 2005 MEB examination (recorded on DD Forms 2807-1 and 2808), 5 months prior to separation, the CI reported chronic knee pain which caused her knees to swell, “sometimes lock and give out.”  The CI reported trying an array of knee braces to help the pain.  Physical examination showed the bilateral knees were tender over the patella and the medial and lateral aspect.  Anterior and posterior drawer sign and Murray’s sign were negative to both knees.  The examiner found no valgus or varus laxity and motor strength was normal.     

The 13 September 2005 MEB NARSUM examination, 2 months prior to separation, noted complaints of worsened bilateral knee pain that recurred after running for 2-3 months.  The CI stated she “hears some cracking and popping of the knees, ankles, hips and elbows.”  The examiner referred to and annotated the physical examination findings performed on 4 August 2005. 

At a physical therapy appointment in October 2005, the CI reported bilateral knee pain of an insidious onset for the past few years.  She described her pain as intermittent and sharp rated as 6/10 when active.  She admitted that physical therapy helped with flexibility, however it did not decrease the pain.  The CI stated that it was more painful to walk up the stairs than down.  She also reported pain when cleaning the house.  Physical examination found tenderness to palpation over the iliotibial band at the distal insertion bilaterally, however other manipulative testing was negative.  The CI had full active range of motion in flexion and extension and a normal gait.  The examiner opined “bilateral iliotibial band friction syndrome.”  

There was no VA Compensation and Evaluation examination in evidence proximate to separation due to the CI not appearing for a scheduled examination therefore the rating decision was based on STR. 

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the bilateral knee pain condition 0%, coded 5099-5003 (arthritis, degenerative), citing no evidence of joint instability or loss of joint motion; pain constant and minimal.  The VA rated the bilateral knee condition 0% coded 5099-5010 (arthritis, due to trauma), based on the STR and PEB findings.  

The panel was initially charged with determining whether the bilateral knees were reasonably justified as separately unfitting and warranted unbundling.  In this case, both knees failed retention standards and were profiled and implicated in the commander’s statement.  Panel members agreed that each knee could be reasonably justified as separately unfitting.  The panel then proceeded its rating recommendations.  There was no radiographic evidence of degenerative arthritis, limitation of motion, or evidence of painful motion for a minimum compensation rating of 10% under either medical diagnostic code 5003 or 5010.  There was no VASRD route to a rating higher the PEB 0% adjudication.  After due deliberation, and considering all of the evidence, the panel concluded that there was insufficient cause to recommend a change in the PEB adjudication for the bundled bilateral knee pain condition.

BOARD FINDINGS:  In the matter of the bilateral knee condition and IAW VASRD §4.71a, the Board unanimously recommends no change in the PEB adjudication.  There are no other conditions within the panel’s scope of review for consideration.  The panel, therefore, recommends that there be no modification or re-characterization of the CI’s disability and separation determination.  

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20150611, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

AR20170007977, XXXXXXXXXXXXXXXXXXXXX

XXXXXXXXXXXXXXXXXXXXX

Dear XXXXXXXXXXXXXXXXXXXXX:

	The Department of Defense Physical Disability Board of Review (DoD PDBR) reviewed your application and found your separation disability rating and your separation from the Army for disability with severance pay to be accurate.  I have reviewed the Board’s recommendation and record of proceedings (copy enclosed), and I accept its recommendation.  I regret to inform you that your application to the DoD PDBR is denied.  

	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 been provided to the counsel you listed on your application, XXXXXXXXXXXXXXXXXXXXX.

Sincerely,					      
						      					
Enclosure