RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXX	CASE:  PD-2016-00195
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20080826

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E4, Fire Support Specialist, medically separated for “bilateral knee pain,” rated 10% each knee, with a combined disability rating of 20%. 

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 – 20080508 	VARD – 20090217 	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Bilateral Knee Pain	5003	10%  	Chondromalacia Patella, Right Knee	5299-5260	10%	20081229	
		10%	Chondromalacia Patella, Left Knee	5299-5260	10%	20081229	
COMBINED RATING:  20%	COMBINED RATING OF ALL VA CONDITIONS:  50%	

ANALYSIS SUMMARY:  

Bilateral Knee Pain.  According to the service treatment record (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s bilateral knee condition began in 2004 without specific injury.  Magnetic resonance imaging (MRI) done December 2006 showed chondromalacia patella in the left and right knees.  

At the 28 August 2007 MEB examination, 12 months prior to separation, the CI reported bilateral knee pain with prolonged walking and running.  Physical examination showed a negative Lachman’s test.  Range of motion study was performed by physical therapy on 10 August 2007 and showed right and left knee flexion after repetition of 130 degrees (normal 140) and right and left knee extension after repetition of 0 degrees (normal).  Painful motion was not addressed.  

The 28 February 2008 MEB NARSUM addendum, 6 months prior to separation, the CI reported daily flare-ups with overuse any time he was on his feet or walking.  The MEB physical examination noted a normal gait without edema or effusion bilaterally.  Tests for ligamentous instability or meniscal pathology were negative.  

The 14 March 2008 MEB physician’s memorandum to the PEB indicated that there was no significant change in the CI’s bilateral knee conditions, but ROM measurements were repeated on 21 February 2008, and knee ROM bilaterally was limited by pain with no significant decrement in the ROM after 3 repetitions.  Actual measurements were not provided.

At the 29 December 2008 VA Compensation and Pension (C&P) evaluation, performed 4 months  after separation, the CI reported he could barely walk half to one block before pain in both knees stopped him.  On examination there was no tenderness or ligamentous instability in either knee.  ROM study of the right knee after repetition showed 0 degrees of extension and 120 degrees of flexion.  ROM study of the left knee after repetition showed extension of 0 degrees and flexion of 110 degrees.  The examiner noted pain with flexion in both knees.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB combined the right and left knee conditions under a single service disability code of 5003 (degenerative arthritis) and rated each knee separately at 10% each for a combined disability rating of 20%, citing painful motion of each knee.  The VA likewise rated each knee at 10% each, coded analogously to 5260 (leg, limitation of flexion), citing leg flexion limited to 45 degrees for each knee.  

Panel members considered that the objective findings and associated disability for each knee were identical, and agreed that the respective ratings should therefore be the same.  The panel concluded that there was sufficient evidence of painful motion and functional loss to support a 10% rating for each knee IAW §4.59 and §4.40.  In considering routes to a higher rating however, there was no limitation of motion which attained a minimum rating under the diagnostic codes for limitation of flexion (5260) or extension (5261).  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).  There was therefore no VASRD §4.71a route to a rating higher than the 10% for each knee, adjudicated by the PEB, 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 condition.  

BOARD FINDINGS:  In the matter of the bilateral knee condition, 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 20160331, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

	

AR20170014130, XXXXXXXXXXXXXXXXXXX

XXXXXXXXXXXXXXXXXXX

Dear XXXXXXXXXXXXXXXXXXX:

	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