RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2017-01713
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20090105

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E3, Cable Installation and Maintenance Specialist, medically separated for “bilateral knee pain due to tibial stress reactions” rated 10% for the left knee and 10% for the right knee, with a combined disability rating of 20%.  

CI CONTENTION:  “Review 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 Medical Evaluation Board (MEB), but determined by the PEB 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.  The panel’s authority is limited to assessing the fairness and accuracy of PEB rating determinations and recommending corrections when appropriate.  The panel’s assessment of the PEB rating determination is based on review of medical records and all available evidence relevant to application of the Veterans Affairs Schedule for Rating Disabilities (VASRD) standards for 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, which operates 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 disability at the time of separation.  

RATING COMPARISON:  

SERVICE PEB - 20080908	VARD - 20090303	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Left Knee Pain due to Tibial Stress Reactions  	5299-5262	10%	Bilateral Knee X-Ray Evidence of Degenerative Arthritis	5003	10%	20081107	
Right Knee Pain due to Tibial Stress Reactions	5299-5262	10%					
COMBINED RATING:  20%	COMBINED RATING OF ALL VA CONDITIONS:  10% 	

ANALYSIS SUMMARY:  

Bilateral Knee Pain due to Tibial Stress Reactions.  According to the service treatment record and MEB narrative summary (NARSUM), the CI’s bilateral knee condition began within 4 months after entering active duty, with no reports of direct trauma.  Despite increased physical restrictions and medications, the CI’s bilateral knee/leg pain continued and she was referred to the MEB.  During the 9 May 2008 primary care clinic appointment, 8 months prior to separation, the CI reported continued bilateral leg pain.  Bone scan studies indicated bilateral stress reactions in the lower legs.  Examination of both knees revealed full range of motion (ROM).  Assessment testing for meniscal injury or joint instability was negative.  At the 5 June 2008 orthopedic evaluation, bilateral knee ROM noted normal extension and decreased flexion to 117 degrees on the left (normal 140) and 121 degrees on the right.  The 9 July 2008 MEB NARSUM examination, 6 months prior to separation, noted complaints of longstanding bilateral knee and lower leg pain as well as local swelling and a sense of knee joint laxity.  Her physical examination revealed tenderness about both knees and both middle aspects of the lower legs.  She exhibited a non-antalgic gait.  Knee ROM remained essentially unchanged from one month prior.  

At the 7 November 2008 VA Compensation and Pension (C&P) examination, 2 months before separation, the CI reported bilateral knee pain that was aggravated by physical activity.  Her PE revealed a normal gait and posture.  Both knees and lower extremities were normal in appearance and function.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the left and right knee conditions 10% each, both coded 5299-5262 (analogous to tibia and fibula, impairment of), citing slight leg impairment.  The VA rated the bilateral knee condition 10%, coded 5003 (arthritis, degenerative), based on the C&P examination, citing X-ray evidence of bilateral knee osteophyte formation.  

Panel members considered that the objective findings and associated disability for each knee were identical, and agreed with the PEB 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.  There was no limitation of motion which attains a minimum rating under the diagnostic codes for limitation of flexion (5260) or extension (5261).  No additional functional limitation was evidenced by the examinations.  There was therefore no VASRD §4.71a higher rating option than the 10% adjudicated by the PEB under any applicable or alternate code.  After due deliberation, considering all the evidence and mindful of VASRD §4.3 (reasonable doubt), the panel concluded there was insufficient cause to recommend a change in the PEB’s adjudication for the bilateral knee pain due to tibial stress reactions.  

BOARD FINDINGS:  In the matter of the bilateral knee conditions and IAW VASRD §4.71a, the panel recommends no change in the PEB adjudication.  There are no other conditions within the panel’s scope of review for consideration.  Therefore, the panel recommends 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 20170331, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Record 

AR20180008169 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