RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXX	CASE:  PD-2015-02116
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20020424

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E5, Infantryman, medically separated for “retropatellar pain syndrome (RPPS)” with a disability rating of 10%.

CI CONTENTION:  “The knees are getting worse in pain limit due to time, locking and clicking at times.”  The CI’s 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 - 20030714	VARD - 20031022	
Condition	Code	Rating	Condition	Code	Rating	Exam	
RPPS	5099-5003	10%	Left Knee, PFPS	5099-5019	10%	20030815	
			Right Knee, PFPS		10%		
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  50%	

ANALYSIS SUMMARY:  

RPPS of the Bilateral Knees.  The PEB combined the left and right knees as a single unfitting condition coded analogously to 5003 (degenerative arthritis) and rated 10%.  The panel’s initial charge in this case was directed at determining if the PEB’s approach of combining conditions under a single rating was justified in lieu of separate ratings.  When the panel recommends separate fitness recommendations in this circumstance, its recommendation may not produce a lower combined rating than that of the PEB.  The evidence for the knees are presented together with attendant recommendations regarding separate unfitness and separate rating, if indicated.  

According to the service treatment record (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s knee conditions began in January 1997 with a long history of bilateral knee pain.  Radiographic studies revealed degenerative changes in both knees.  There was no surgical indication and conservative treatment did not result in improvement sufficient to allow unrestricted duty. 

At the 25 April 2003 MEB physical therapy range of motion (ROM) study, 5 months prior to separation, the CI complained of 10/10 bilateral knee pain.  On examination there was 115 degrees of left knee flexion (normal 140) and 125 degrees of right knee flexion.  There was 2 degrees of extension for each knee.  The examiner did not address painful motion.

The 29 May 2003 MEB NARSUM examination, 4 months prior to separation, noted complaints of severe bilateral knee pain with physical activities.  The physical examination showed mild swelling and full active ROM.  The examiner noted that there was no instability or evidence of meniscal injury.  

At the 15 August 2003 VA Compensation and Pension (C&P) evaluation, performed 1 month before separation, the CI reported pain in both knees since 1996.  The physical examination showed a normal gait.  The focused examination showed no swelling or effusion.  There was “tenderness at the distal, medial and lateral aspects of both knees” as well as kneecap tenderness.  There was no instability noted on either knee.  ROM testing showed flexion of 60 degrees bilaterally and extension of 0 degrees.  Painful motion was noted in each knee.  The examiner noted that ROM of the right and left knee joints was affected by pain, fatigue, and lack of endurance, but couldn’t state if there was any additional limitation after repetitive use.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the bilateral knee conditions 10%, analogously coded 5099-5003, citing full ROM, bilateral crepitus with pain on palpation and no evidence of ligamentous laxity.  The VA rated the knees separately at 10% each analogously coded 5099-5019 (bursitis), based on the C&P examination 1 month before separation, citing severe pain and limitation of motion with 60 degrees of flexion.  

The panel first considered if the knees, having been de-coupled from the combined PEB adjudication, remained separately unfitting as established above.  The commander’s statement and other STR evidence did not provide any information which would permit the panel to discriminate the performance limitations attributable to one knee over the other.  Both knees exhibited painful motion at the NARSUM and VA examinations.  Since undue speculation would be required to conclude that left and right knee impairment would not have unacceptably interfered with MOS performance, members agreed that each knee was reasonably justified as separately unfitting.  

There was no limitation of flexion or extension in either knee that supported a rating under the VASRD diagnostic codes for limitation of motion (5260 or 5261).  There was no history or evidence 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 those codes for either knee.  There was no fracture, nonunion or malunion of the femur or tibia to support consideration under the respective codes for knee impairment related to long bone conditions (5255, 5262) in either knee.  However, there was evidence of painful motion with functional loss supporting a 10% rating for each knee (based on §4.59, §4.40 and §4.45).  After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the Board recommends a disability rating of 10% each for the left and right knee conditions for a combined rating of 20%, coded 5099-5003. 

BOARD FINDINGS:  In the matter of the bilateral knee condition, the Board unanimously recommends that each joint be separately adjudicated as follows: an unfitting right knee condition analogously coded 5099-5003 and rated 10%, and an unfitting left knee condition, analogously coded 5099-5003 and rated 10%, both IAW VASRD §4.71a.

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	
Left Knee RPPS	5099-5003	10%	
Right Knee RPPS	5099-5003	10%	
COMBINED	20%	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20150721, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

AR20170011088, XXXXXXXXXXXXXXXXXXX

XXXXXXXXXXXXXXXXXXX

Dear XXXXXXXXXXXXXXXXXXX:

	The Department of Defense Physical Disability Board of Review (DoD PDBR) reviewed your application and found that your disability rating should be modified but not to the degree that would justify changing your separation for disability with severance pay to a permanent retirement with disability.  I have reviewed the Board’s recommendation and record of proceedings (copy enclosed) and I accept its recommendation.  This will not result in any change to your separation document or the amount of severance pay.  A copy of this decision will be filed with your Physical Evaluation Board records.  I regret that the facts of the case did not provide you with the outcome you may have desired.
  
	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 also been provided to the Department of Veterans Affairs.

Sincerely,	
Enclosure