RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2016-00250
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20090827

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 “chronic bilateral knee pain” rated 10% for each knee, with a combined disability rating of 20%.

CI CONTENTION:  “I was told by more than one member of the Army that I was only able to use 1 condition to go through my medical board.  I also was forced to pay for my own MRI in order to prove I had a condition that needed attention.  It wasn’t until I paid for the MRI that they finally sent me to an orthopedic.  Up until that point I was only seen by a PA, and was never helped.”  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 – 20090603	VARD – 20150502	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic b/l Knee Pain… 10% Right…10% Left…	5099-5003	10%	PFPS & Osteoarthritis, Right	5003-5260	10%	20150319	
		10%	PFPS, Left	5260	10%		
COMBINED RATING:  20%	COMBINED RATING OF ALL VA CONDITIONS:  80%	

ANALYSIS SUMMARY:  

Chronic Bilateral Knee Pain.  The PEB rated the right and left knee conditions combined at 20% (indicating they were rated at 10% each), coded analogously to 5003.  The evidence for the right and left knee conditions is presented together, because all examinations in evidence were for the bilateral knee conditions.  

According to the service treatment record (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s bilateral knee condition began in January 2006 without specific injury reported.  In January 2008 bilateral knee X-rays were normal.  Magnetic resonance imaging of the right and then left knee performed in approximately August 2008 showed patellar chondromalacia.  At the time of the 14 November 2008 orthopedic clinic appointment, 9 months prior to separation, the CI reported bilateral knee pain, right greater than left, that would vary at different times regarding which knee hurt more.  The pain was aggravate by stairs or high impact activity.  Pain was rated at 4/10, and was relieved with non-steroidal anti-inflammatory drugs.  The CI denied swelling, instability and locking, but indicated his knees would “catch” occasionally.  On examination the knees appeared normal with no tenderness or swelling, and ROM was described as “full range of motion” bilaterally.  The alignment of the patella was normal with normal patellar tracking.  Testing for ligamentous instability was negative.  There was a positive grind test bilaterally (test for patellofemoral syndrome).  The diagnosis was bilateral patellofemoral syndrome and an MEB was recommended.  

The 1 May 2009 MEB NARSUM, 4 months prior to separation, noted complaints of chronic bilateral knee pain (rated 5-6/10) aggravated by stairs, carrying over 20-25 pounds, bending at the knees, and extended walking.   Physical examination noted no tenderness or gross deformities, and mild pain at extreme flexion bilaterally.  Testing for ligamentous instability was negative bilaterally, but patellar grind test was positive bilaterally.  At the 4 May 2009 physical therapy (PT) examination for the MEB, 4 months prior to separation, left knee ROM after 3 repetitions was extension 4 degrees (normal 0) and flexion 134 degrees (normal 140)and right knee ROM was extension 5 degrees and flexion 135 degrees, and was limited by pain bilaterally.  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 left and right knee each at 10%, coded 5099-5003 (analogous to degenerative arthritis), citing painful motion.  The VA performed an initial Compensation and Pension examination more than 5 years after separation, which was not probative for the panel’s rating recommendation for disability at the time of separation.  The PEB assigned a 10% rating for each knee, therefore, the panel reviewed to see if a higher rating for either knee was supported under any applicable VASRD code.  There was no limitation of motion which supported a higher rating for either knee under the diagnostic codes for limitation of flexion or extension (5260, 5261).  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).  There was therefore no VASRD §4.71a route to a rating higher than the 10% 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 adjudications for the chronic bilateral knee pain condition.
  
Contended PEB Conditions:  History of Concussion, No Sequela and Bilateral Tympanic Membrane Perforations, Healed Uneventfully.  The panel’s main charge is to assess the fairness of the PEB’s determination that the contended conditions were not unfitting.  Neither of the conditions was profiled, implicated in the commander’s statement or judged to fail retention standards.  There was no performance-based evidence from the record that either of these 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 either of the contended conditions and so no additional disability ratings are recommended.  

BOARD FINDINGS:  In the matter of the chronic 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 history of concussion, no sequela and bilateral tympanic membrane perforations, healed uneventfully 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 modification or re-characterization of the CI’s disability and separation determination.  

The following documentary evidence was considered:

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

	

AR20170015186, 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