RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2015-02211
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20090424

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an Reserve E5, Construction Equipment Operator, medically separated for “bilateral knee pain” with a disability rating of 20%.

CI CONTENTION:  The CI requested a review of 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 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 - 20090129	VARD - NA	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Bilateral Knee Pain…	5099- 5003	20%	No VA Exam in Evidence	
Hyperlipidemia	Not Unfitting		
COMBINED RATING: 20%	COMBINED RATING OF ALL VA CONDITIONS:  NA	

ANALYSIS SUMMARY:  

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 with left knee pain in 2000 and right knee pain in in April 2008 and was attributed by the CI to the increased activities associated with military training.  Magnetic resonance imaging (MRI) studies of the right knee in August 2008 were negative as were X-rays of both knees.  There was no surgical indication, and conservative treatment including physical therapy, cortisone injections, and bracing did not result in improvement sufficient to allow unrestricted duty.  

At the MEB examination (recorded on DD Forms 2807 and 2808) dated 12 November 2008, 6 months prior to separation, the CI reported “right and left” knee pain, numbness swelling, and locking.  The physical examination was unremarkable.  The MEB NARSUM was dated 4 December 2008, 5 months prior to separation.  The CI reported bilateral knee pain that restricted activity.  On physical examination, the knees were stable and swelling absent.  Tenderness along the lateral tendons was noted bilaterally, right greater than left.  The gait was abnormal due to pain and favored the right knee.  The range of motion (ROM) testing of the right knee lacked 7 degrees of extension (0 normal) and flexion was limited to 125 degrees (140 normal).  The right knee was positive for crepitus upon compression and stable to varus, valgus stress.  The ROM of the left knee was recorded as extension to 0 degrees (0 normal) and flexion to 130 degrees (140 normal).  There was no VA 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 pain 20% (10% each with the bilateral factor applied) coded 5003 (degenerative arthritis), citing an abnormal gait, painful motion bilaterally, and limited motion on the right.  There was no limitation of motion of either knee which supported a rating under the diagnostic codes for limitation of flexion (5260).  The limitation in extension to 7 degrees of the right knee warranted a 10% rating under VASRD code 5261, but this provided no additional benefit to the CI.  There was evidence of painful motion bilaterally with functional loss which supported the 10% rating (based on §4.59, §4.40 and §4.45) adjudicated by the PEB, although the use of the code 5003 is not warranted in the absence of pathology on X-ray.  There was no evidence of instability, meniscal pathology, or a prior fracture with mal-union to support the use of another code.  Therefore, there was no VASRD §4.71a route to a rating higher than the PEB adjudication, 10% for each knee, under any applicable code.  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.  

Contended PEB Conditions:  Hyperlipidemia.  The panel’s main charge is to assess the fairness of the PEB’s determination that the contended condition was not unfitting.  The contended condition was not profiled, implicated in the commander’s statement nor judged to fail retention standards.  There was no performance-based evidence from the record that the condition 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 the contended condition and so no additional disability rating is recommended.  

BOARD FINDINGS:  In the matter of the bilateral knee pain and IAW VASRD §4.71a, the panel unanimously recommends no change in the PEB adjudication.  In the matter of the contended hyperlipidemia condition, the panel unanimously recommends no change from the PEB determination as not unfitting.  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 20150605, with attachments
Exhibit B.  Service Treatment Record

AR20170012124, 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,