RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2016-00310
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20090507

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E7, Intelligence Analyst, medically separated for “arthritis due to trauma, bilateral knee pain ” with a 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 - 20090409	VARD - 20090630	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Arthritis Due to Trauma, Bilateral Knee Pain	5010	10%	Degenerative Arthritis, Right Knee	5003-5260	10%	20090608	
		10%	Degenerative Arthritis, Left Knee	5003-5260	0%	20090608	
COMBINED RATING:  20%	COMBINED RATING OF ALL VA CONDITIONS:  30%	

ANALYSIS SUMMARY:

Arthritis Due to Trauma, Bilateral Knee Pain.  According to the service treatment record and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI first experienced minor knee pain in 1998 and developed more significant bilateral pain after a series of motor vehicle accidents beginning in August 2007.  Magnetic resonance imaging studies in 2008 showed likely chondromalacia (softening and thinning of the kneecap cartilage) of the patella in both knees.  There was no surgical indication.

An 18 September 2008 orthopedic physical examination, 8 months prior to separation, documented range of motion (ROM) with flexion to 125 degrees (normal 140) and extension to 0 degrees (normal) bilaterally. Crepitus was present.  On 23 October 2003, a primary care examiner noted painful motion of each knee and “good ROM.”

The 11 March 2009 MEB examination (recorded on DD Form 2808), 2 months prior to separation, showed a normal gait and heel-toe walking.  With a slow jog, a right leg limp developed, and with a minimal attempt at jumping, the CI complained of increased bilateral knee pain.  Bilateral tenderness and crepitus were present, right greater than left, and she could squat 3 times to 70, 65 and 70 degrees respectively.  She could lift 25 pounds to the waist by bending the left knee more than the right, and by shifting weight to the left side.  After three repetitions, right knee flexion was to 100 degrees and extension to 0 degrees.  Left knee flexion was to 115 degrees and extension to 0 degrees.  

At the 24 March 2009 MEB NARSUM examination, the CI reported bilateral knee pain, right worse than left, and popping and grinding in both knees with any movement.  Walking greater than one mile exacerbated the pain, and she could not squat.  The right knee pain caused difficulty going up stairs, while the left knee pain caused more difficulty going down stairs.

During the 8 June 2009 VA Compensation and Pension (C&P) evaluation, one month after separation, the CI complained of daily and constant bilateral knee pain that prevented walking more than a mile, dancing or climbing stairs.  She reported “no significant effects” on her occupation and use of a right knee brace at times.  Physical examination showed a normal gait and posture, and no knee swelling.  Bilateral knee tenderness and crepitus were present, and a test for possible meniscal injury was negative.  Each knee demonstrated flexion to 120 degrees and extension to 0 degrees with painful motion present in the right knee but absent in the left. There was no additional limitation after repetitive motion of either knee.  X-rays showed degenerative changes in both knees.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated each knee condition 10%, coded 5010 (arthritis, due to trauma), appropriately applied bilateral factoring and cited motion limited by pain.  The VA rated the left knee condition 0%, coded 5003-5260 (leg, limitation of flexion), based on the C&P examination 1 month after separation, citing lack of objective evidence of painful motion.  The right knee was rated 10% under the same code.  Panel members considered that the objective findings and associated disability for each knee were similar, and concluded that identical ratings were therefore warranted.  The presence of painful motion with functional loss was reasonably conceded in support of a 10% rating (based on §4.59, §4.40 and §4.45), as adjudicated by the PEB.  There was no limitation of motion which supported a higher rating under the diagnostic codes for limitation of flexion or extension (5260, 5261), and no history of dislocated meniscus or loose body causing frequent locking with recurrent effusions to support a rating under the 5258 code.  Finally, 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 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 left and right knee conditions.  

BOARD FINDINGS:  In the matter of the left and right knee conditions and IAW VASRD §4.71a, the panel unanimously recommends no change in the PEB adjudication.  There are no other conditions within the panel’s scope of review for consideration.  The panel, therefore, recommends 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

	

AR20170015264, 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