RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2015-01802
BRANCH OF SERVICE:  ARMY 	SEPARATION DATE:  20070608

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E7, Human Resources Specialist, medically separated for “chronic bilateral knee pain” with a disability rating of 0%.

CI CONTENTION:  “Review all conditions.”  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 conditions 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 - 20070206	VARD - 20071217	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Bilateral Knee Pain	5024	0%	PFS, Left Knee	5299-5260	10%	20070802	
			PFS, Right Knee	5299-5260	10%		
Hypertension	Not Unfitting 	Hypertension	7101	0%		
Anemia		Anemia	7700	0%		
Idiopathic Urticaria		Idiopathic Urticaria	7825	NSC		
COMBINED RATING:  0%	COMBINED RATING OF ALL VA CONDITIONS:  20%	

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 bilateral knee pain condition began in 1999 without specific injury.  She was able to continue duty with profile limitations, but had progression of her symptoms.  A review of the records shows the CI was typically noted to have full range of motion (ROM) of the extremities.  The CI was seen in primary care on 30 October 2006 for a renewal of her profile.  She had a normal gait and movement of her extremities, but was also noted to have been on a permanent L3 profile since 2002.  She was then referred for an MEB.  

At the 5 January 2007 MEB NARSUM examination, 5 months prior to separation, the CI reported a 7-year history of bilateral knee pain and denied recent history of trauma, locking, or radicular symptoms.  The physical examination, also recorded on the DD Form 2808, showed full ROM for both knees.  There was no atrophy, edema, patellar tilt, or laxity.  The CI did have a positive patellar (kneecap) grind and tenderness to palpation.  Swelling above the kneecaps was documented.  The knees were stable and without signs of meniscal irritation.  X-rays were unremarkable.  

At the 2 August 2007 VA Compensation and Pension evaluation, performed 2 months after separation, the CI reported bilateral knee pain with significant pain with bending.  The CI also reported that her left knee has locked several times after repetitive bending and denied significant instability.  She also denied any effect on her usual occupation and denied flare-ups or use of assistive devices.  The physical examination showed a normal gait.  Extension was normal bilaterally.  The CI was able to bilaterally flex to 125 degrees (normal 140), and after repetitive motion to 130 degrees.  Motion was pain free.  The knees were stable and without signs of meniscal irritation.  There was tenderness bilaterally.  The X-rays of both knees were normal.  Two years after separation on 20 March 2009, the CI was evaluated for Gulf War related conditions.  The ROM of the knees was normal bilaterally at 140 degrees of flexion and 0 degrees extension (normal 0).  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the bilateral knee condition 0%, coded 5024 (tenosynovitis), citing without limitation of motion.   The VA rated the each knee condition 10% for a combined 20%, analogously coded 5260 (leg, limitation of flexion), citing documentation of painful motion of a major joint.  The panel noted that the VA examiner actually recorded that motion was pain free although the CI reported pain with bending.  There was no evidence of painful motion with functional loss supporting a 10% rating (based on §4.59, §4.40 and §4.45).  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 ROM recorded by the VA examiner was an outlier from multiple prior examinations and from a VA evaluation 2 years after separation.  Regardless, the limitation in motion was not compensable in absence of X-ray findings and painful motion.  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).  No additional functional limitation was evidenced by the examinations, and VA examination showed evidence of pain free range of motion.  Therefore the panel concluded the evidence did not support a rating higher than the 0% adjudicated by the PEB.  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 pain condition.

Contended PEB Conditions:  Hypertension, Anemia, and Idiopathic Urticaria.  The panel’s main charge is to assess the fairness of the PEB’s determination that the contended conditions were not unfitting.  None of the conditions were profiled or implicated in the commander’s statement.  All were judged to meet retention standards.  The commander’s statement reported that the CI is physically capable of reasonably performing her duties, has had no problems with her duty performance, and recommended that the CI be considered fit for duties in her current duty position.  There was no performance-based evidence from the record that any of the conditions significantly interfered with satisfactory duty performance at separation.  After due deliberation, the panel concluded that there was insufficient cause to recommend a change in the PEB fitness determination for any of the contended conditions and so no additional disability ratings are recommended.  

BOARD FINDINGS:  In the matter of the bilateral knee pain condition and IAW VASRD §4.71a, the panel unanimously recommends no change in the PEB adjudication.  In the matter of the contended hypertension, anemia, and idiopathic urticaria conditions, the panel unanimously recommends no change from the PEB determinations as not unfitting.  There are no other conditions within the panel’s scope of review for consideration.  The panel, 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 20150602, w/attachments
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

AR20170009563, 
XXXXXXXXXXXXXXXXXX

XXXXXXXXXXXXXXXXXX
Dear XXXXXXXXXXXXXXXXXX:

	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