RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXXXX	CASE:  PD-2015-01730
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20051220

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was a National Guard E2, Initial Entry Trainee, medically separated for “bilateral knee and shin pain,” with a disability rating of 0%.  

CI CONTENTION:  The CI’s conditions worsened.  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 - 20051208	No VARD - NA	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Bilateral Knee and Shin Pain	5099-5003	0%	No VA Exam in Evidence	
COMBINED RATING:  0%	COMBINED RATING OF ALL VA CONDITIONS:  NA	

ANALYSIS SUMMARY:  

Bilateral Knee and Shin Pain.  According to the service treatment record (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s bilateral knee and shin pain began in May 2005 without specific trauma, but generally after running, during basic training.  At the Physical Therapy (PT) examination dated 27 September 2005, 3 month prior to separation, and following convalescent leave, the CI continued to complain of 2/10 bilateral shin pain increasing to 5/10 shin pain, and 1/10 knee pain, after 1½ laps.  Physical examination showed a normal gait and a full squat with no pain.  There was slight pain bilaterally on hopping.  The 4 October 2005 PT note indicated no knee pain with 5/10 shin pain.  

The 17 November 2005 Orthopedic clinic evaluation, 1 month prior to separation, noted the CI had shin pain on return to training with “no pain if he doesn’t run (except this A.M.).”  Physical examination showed full active range of motion of the knee with patellofemoral tenderness and no effusion.  There was tibial tenderness right greater than left.  X-rays were negative.  Bone scan showed increased uptake over the bilateral tibial cortices, knees and feet.  There was no surgical indication, and conservative treatment did not result in improvement sufficient to allow completion of initial entry training.  The MEB forwarded “bilateral knee and shin pain” for PEB adjudication.  

The 17 November 2005 MEB NARSUM examination, 1 month prior to separation, noted complaints of bilateral shin and knee pain.  Physical examination showed full active range of motion of the knees.  There was positive patellofemoral compression without effusion.  There was tender to palpation over the right greater than left medial tibial plateau, with diffuse tenderness along the tibial shaft.  The CI was neurovascularly intact with no edema or skin changes.  There was no VA Compensation and Pension examination in evidence proximate to separation.

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the bilateral knee and shin pain 0%, coded 5003 (Arthritis, degenerative (hypertrophic or osteoarthritis), citing slight pain with “no loss of joint motion or evidence of instability.”  The PEB combined the right and left knee pain, and right and left shin pain conditions as a single unfitting condition coded analogously to 5003 (arthritis, degenerative) and rated 0%, citing no loss of joint motion or evidence of instability and “rated for pain - slight occasional” with likely application of the US Army Physical Disability Agency (USAPDA) pain policy.  The 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.  There was no VA rating decision in evidence.  

The profile was for bilateral knee/shin pain and the MEB determined that bilateral knee and shin pain did not meet retention standards.  The commander’s statement noted only left knee pain as interfering with participation.  STRs indicated both the left and right lower leg conditions were essentially equivalent and the panel adjudged that the left and right tibial plateau stress fractures/shin splints were each reasonably unfitting.  However, there was no evidence of knee joint degenerative changes for a 10% rating under code 5003 for “X-ray evidence of involvement of 2 or more major joints,” and insufficient evidence of knee limited motion or painful motion for any rating above 0% for either knee separately.  There was insufficient evidence of at least “slight knee or ankle disability" on either the left or the right leg for any rating above 0% under code 5262 (tibia and fibula, impairment).  Although ideal coding would be 5299-5262 at 0% for each side, the combined 0% rating would offer no benefit.  After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the panel concluded that there was insufficient cause to recommend a change in the PEB adjudication for the bilateral knee and shin pain.  

BOARD FINDINGS:  In the matter of the bilateral knee and shin pain and IAW VASRD §4.71a, the panel unanimously recommends no change in the PEB adjudication.  There were 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 20150625, with attachments
Exhibit B.  Service Treatment Record

AR20170008862, 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.

Sincerely,					      
						      					
Enclosure